Pharmacological and Pharmaceutical Aspects of the Management of Arterial Hypertension and Hypertensive Crisis: Analysis of Current Trends and Pharmacoeconomic Aspects

Introduction. Arterial hypertension (AH) remains one of the leading causes of cardiovascular morbidity and mortality, imposing a substantial clinical and pharmacoeconomic burden on healthcare systems. Despite the wide availability of antihypertensive medications, blood pressure control remains inadequate, and hypertensive crisis (HC) continues to pose a serious threat to patients' lives. Objective. To perform a systematic analysis of the pharmacological, pharmaceutical, and pharmacoeconomic aspects of arterial hypertension and hypertensive crisis management in the context of current clinical guidelines and the structure of the pharmaceutical market. Methods. A content analysis of the clinical guidelines issued by the American College of Cardiology/American Heart Association (ACC/AHA), the European Society of Cardiology/European Society of Hypertension (ESC/ESH), and the World Health Organization (WHO), as well as publications in peer-reviewed scientific journals, was conducted. A comparative pharmacological analysis of the major classes of antihypertensive drugs, a pharmaceutical analysis of registered dosage forms in the Republic of Kazakhstan and the Eurasian Economic Union (EAEU), and a pharmacoeconomic analysis of market structure, drug availability, and treatment costs were performed. Results. The analysis demonstrated that contemporary antihypertensive therapy is primarily based on angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, β-blockers, diuretics, and fixed-dose combination therapies. Combination products accounted for the largest market share (26.9%) within the antihypertensive drug segment. Arterial hypertension represented up to 38% of all patients receiving outpatient pharmaceutical care, while the average treatment cost per patient remained relatively low (8,688.95 KZT in 2025). In the management of hypertensive crisis, priority is given to the controlled reduction of blood pressure using parenteral dosage forms. Alternative routes of drug administration, particularly intranasal delivery systems, were identified as promising therapeutic approaches. Discussion. The leading market position of fixed-dose combinations is consistent with the emphasis on combination regimens in current hypertension management. Relatively low per-patient treatment costs may reflect the use of affordable generics but do not establish treatment effectiveness. Intranasal drug delivery warrants further clinical and pharmaceutical evaluation before implementation. Conclusions. A comprehensive strategy integrating rational pharmacotherapy, optimization of dosage forms, and pharmacoeconomic evaluation is essential for improving the effectiveness of arterial hypertension management and preventing hypertensive crises.