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Особенности кардиопротективного действия зофеноприла во вторичной профилактике сердечно-сосудистых заболеваний
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Аннотация
Зофеноприл – один из последних появившихся в арсенале ингибиторов ангиотензинпревращающего фермента (ИАПФ) препарат – обладает высокой липофильностью. Это свойство обусловливает высокую и быструю абсорбцию, существенную долю экскреции с желчью и улучшенную проницаемость тканей, ассоциированную с пролонгированным эффектом ингибирования АПФ в тканях организма.
Это же свойство, вероятно, лежит в основе некоторых эффектов зофеноприла, которыми не обладают другие препараты класса. Так, липофильность в сочетании с антиоксидантной активностью обеспечивают оптимальную антигипертензивную эффективность наряду с антиатерогенным действием. Эти два последних свойства, по всей видимости, вносят основной вклад в снижение смертности после инфаркта миокарда (ИМ), убедительно продемонстрированное в серии клинических исследований SMILE.
Рассмотренные здесь свойства зофеноприла еще раз подтверждают идею о том, что не все ИАПФ одинаково эффективны в лечении артериальной гипертензии и вторичной профилактике после ИМ.
Ключевые слова: зофеноприл, ингибиторы ангиотензинпревращающего фермента, артериальная гипертензия, инфаркт миокарда, ишемическая болезнь сердца, сердечно-сосудистые заболевания, вторичная профилактика.
Это же свойство, вероятно, лежит в основе некоторых эффектов зофеноприла, которыми не обладают другие препараты класса. Так, липофильность в сочетании с антиоксидантной активностью обеспечивают оптимальную антигипертензивную эффективность наряду с антиатерогенным действием. Эти два последних свойства, по всей видимости, вносят основной вклад в снижение смертности после инфаркта миокарда (ИМ), убедительно продемонстрированное в серии клинических исследований SMILE.
Рассмотренные здесь свойства зофеноприла еще раз подтверждают идею о том, что не все ИАПФ одинаково эффективны в лечении артериальной гипертензии и вторичной профилактике после ИМ.
Ключевые слова: зофеноприл, ингибиторы ангиотензинпревращающего фермента, артериальная гипертензия, инфаркт миокарда, ишемическая болезнь сердца, сердечно-сосудистые заболевания, вторичная профилактика.
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Zofenopril is one of the most recent ACE inhibitors; it shows a high lipophilicity. This property determines its high and rapid absorption, a considerable proportion of excretion with bile and improved tissue permeability associated with the prolonged effect of tissue ACE inhibition.
This property must underlie some effects of zofenopril, which are absent in other drugs of this class. Thus, the combination of lipophilicity and antioxidant activity ensures the optimal antihypertensive efficacy along with antiatherogenic activity.
These two latter properties most probably make a major contribution to a reduction in death rates after myocardial infarction, as conclusively demonstrated in a series of SMILE clinical trials.
The above properties of zofenopril support once again the idea that not all ACE inhibitors are equally effective in the treatment of arterial hypertension and in secondary prevention after myocardial infarction.
Key words: zofenopril, ACE inhibitors, essential hypertension, myocardial infarction, coronary heart disease, cardiovascular diseases, secondary prevention.
Полный текст
Список литературы
1. Redon J, Brunner HR, Ferri C et al. Practical solutions to the challenges of uncontrolled hypertension: a white paper. J Hypertens Suppl 2008; 26 (4): S1–14.
2. Mancia G, De Backer G, Dominiczak A et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the 2. Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25 (6): 1105–87.
3. Mancia G, Laurent S, Agabiti–Rosei E et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2009; 18 (6): 308–47.
4. Desideri G, Grassi D, Croce G et al. Different effects of angiotensin converting enzyme inhibitors on endothelin-1 and nitric oxide balance in human vascular endothelial cells: evidence of an oxidant-sensitive pathway. Mediators Inflamm 2008; 305087.
5. Subissi A, Evangelista S, Giachetti A. Preclinical profile of zofenopril: an angiotensin converting enzyme inhibitor with peculiar cardioprotective properties. Cardiovascular Drug Reviews 1999; 17 (2): 115–33.
6. Ranadive SA, Chen AX, Serajuddin ATM. Relative lipophilicities and structuralpharmacological considerations of various angiotensin-converting enzyme (ACE) inhibitors. Pharm Res 1992; 9: 1480–6.
7. DeForrest JM, Waldron TL, Krapcho J et al. Preclinical pharmacology of zofenopril, an inhibitor of angiotensin I converting enzyme. J Cardiovasc Pharmacol 1989; 13: 887–94.
8. Cushman DW, Wang FL, Fung WC et al. Comparisons in vitro, ex vivo, and in vivo of the actions of seven structurally diverse inhibitors of angiotensin converting enzyme (ACE). Br J Clin Pharmacol 1989; 28: 115S–131S.
9. Ambrosioni E, Borghi C, Magnani B. The effect of the angiotensinconverting– enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. The Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators. N Engl J Med 1995; 332 (2): 80–5.
10. Liu X, Engelman RM, Rousou GA et al. Attenuation of myocardial reperfusion injury by sulfhydryl-containing angiotensin converting enzyme inhibitors. Cardiovasc Drugs Ther 1992; 6 (4): 437–43.
11. Evangelista S, Manzini S. Antioxidant and cardioprotective properties of the sulphydryl angiotensinconverting enzyme inhibitor zofenopril. J Int Med Res 2005; 33 (1): 42–54.
12. Napoli C, Bruzzese G, Ignarro LJ et al. Long-term treatment with sulfhydryl angiotensin–converting enzyme inhibition reduces carotid intima-media thickening and improves the nitric oxide/oxidative stress pathways in newly diagnosed patients with mild to moderate primary hypertension. Am Heart J 2008; 156 (6): 1154 e1–8.
13. Bucci M, Roviezzo F, Brancaleone V, et al. ACE–inhibition ameliorates vascular reactivity and delays diabetes outcome in NOD mice. Vascul Pharmacol 2008; 49 (2–3): 84–90.
14. Ambrosioni E, Borghi C, Magnani B. The effect of the angiotensinconverting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. The Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators. N Engl J Med 1995; 332 (2): 80–5.
15. Borghi C, Bacchelli S, Esposti DD et al. Effects of the administration of an angiotensin–converting enzyme inhibitor during the acute phase of myocardial infarction in patients with arterial hypertension. SMILE Study Investigators. Survival of Myocardial Infarction Long-term Evaluation. Am J Hypertens 1999; 2: 665–72.
16. Borghi C, Bacchelli S, Esposti DD et al. SMILE Study. Effects of the early ACE inhibition in diabetic nonthrombolyzed patients with anterior acute myocardial infarction. Diabetes Care 2003; 26: 1862–8.
17. Borghi C, Ambrosioni E, Survival of Myocardial Infarction Long-term Evaluation-2 Working PartyDouble-blind comparison between zofenopril and lisinopril in patients with acute myocardial infarction: results of the Survival of Myocardial Infarction Long-term Evaluation-2 (SMILE-2) study. Am Heart J 2003; 45: 80–7.
18. Claudio Borghi, MD, and Ettore Ambrosioni, MD, on behalf of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) Study Group Bologna, Italy. Am Heart J 2007; 153: 445. e7244. e14.
19. Malacco E. Clin Drug Invest 2005; 25 (3): 175–82.
2. Mancia G, De Backer G, Dominiczak A et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the 2. Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25 (6): 1105–87.
3. Mancia G, Laurent S, Agabiti–Rosei E et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2009; 18 (6): 308–47.
4. Desideri G, Grassi D, Croce G et al. Different effects of angiotensin converting enzyme inhibitors on endothelin-1 and nitric oxide balance in human vascular endothelial cells: evidence of an oxidant-sensitive pathway. Mediators Inflamm 2008; 305087.
5. Subissi A, Evangelista S, Giachetti A. Preclinical profile of zofenopril: an angiotensin converting enzyme inhibitor with peculiar cardioprotective properties. Cardiovascular Drug Reviews 1999; 17 (2): 115–33.
6. Ranadive SA, Chen AX, Serajuddin ATM. Relative lipophilicities and structuralpharmacological considerations of various angiotensin-converting enzyme (ACE) inhibitors. Pharm Res 1992; 9: 1480–6.
7. DeForrest JM, Waldron TL, Krapcho J et al. Preclinical pharmacology of zofenopril, an inhibitor of angiotensin I converting enzyme. J Cardiovasc Pharmacol 1989; 13: 887–94.
8. Cushman DW, Wang FL, Fung WC et al. Comparisons in vitro, ex vivo, and in vivo of the actions of seven structurally diverse inhibitors of angiotensin converting enzyme (ACE). Br J Clin Pharmacol 1989; 28: 115S–131S.
9. Ambrosioni E, Borghi C, Magnani B. The effect of the angiotensinconverting– enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. The Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators. N Engl J Med 1995; 332 (2): 80–5.
10. Liu X, Engelman RM, Rousou GA et al. Attenuation of myocardial reperfusion injury by sulfhydryl-containing angiotensin converting enzyme inhibitors. Cardiovasc Drugs Ther 1992; 6 (4): 437–43.
11. Evangelista S, Manzini S. Antioxidant and cardioprotective properties of the sulphydryl angiotensinconverting enzyme inhibitor zofenopril. J Int Med Res 2005; 33 (1): 42–54.
12. Napoli C, Bruzzese G, Ignarro LJ et al. Long-term treatment with sulfhydryl angiotensin–converting enzyme inhibition reduces carotid intima-media thickening and improves the nitric oxide/oxidative stress pathways in newly diagnosed patients with mild to moderate primary hypertension. Am Heart J 2008; 156 (6): 1154 e1–8.
13. Bucci M, Roviezzo F, Brancaleone V, et al. ACE–inhibition ameliorates vascular reactivity and delays diabetes outcome in NOD mice. Vascul Pharmacol 2008; 49 (2–3): 84–90.
14. Ambrosioni E, Borghi C, Magnani B. The effect of the angiotensinconverting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. The Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators. N Engl J Med 1995; 332 (2): 80–5.
15. Borghi C, Bacchelli S, Esposti DD et al. Effects of the administration of an angiotensin–converting enzyme inhibitor during the acute phase of myocardial infarction in patients with arterial hypertension. SMILE Study Investigators. Survival of Myocardial Infarction Long-term Evaluation. Am J Hypertens 1999; 2: 665–72.
16. Borghi C, Bacchelli S, Esposti DD et al. SMILE Study. Effects of the early ACE inhibition in diabetic nonthrombolyzed patients with anterior acute myocardial infarction. Diabetes Care 2003; 26: 1862–8.
17. Borghi C, Ambrosioni E, Survival of Myocardial Infarction Long-term Evaluation-2 Working PartyDouble-blind comparison between zofenopril and lisinopril in patients with acute myocardial infarction: results of the Survival of Myocardial Infarction Long-term Evaluation-2 (SMILE-2) study. Am Heart J 2003; 45: 80–7.
18. Claudio Borghi, MD, and Ettore Ambrosioni, MD, on behalf of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) Study Group Bologna, Italy. Am Heart J 2007; 153: 445. e7244. e14.
19. Malacco E. Clin Drug Invest 2005; 25 (3): 175–82.
________________________________________________
1. Redon J, Brunner HR, Ferri C et al. Practical solutions to the challenges of uncontrolled hypertension: a white paper. J Hypertens Suppl 2008; 26 (4): S1–14.
2. Mancia G, De Backer G, Dominiczak A et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the 2. Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25 (6): 1105–87.
3. Mancia G, Laurent S, Agabiti–Rosei E et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2009; 18 (6): 308–47.
4. Desideri G, Grassi D, Croce G et al. Different effects of angiotensin converting enzyme inhibitors on endothelin-1 and nitric oxide balance in human vascular endothelial cells: evidence of an oxidant-sensitive pathway. Mediators Inflamm 2008; 305087.
5. Subissi A, Evangelista S, Giachetti A. Preclinical profile of zofenopril: an angiotensin converting enzyme inhibitor with peculiar cardioprotective properties. Cardiovascular Drug Reviews 1999; 17 (2): 115–33.
6. Ranadive SA, Chen AX, Serajuddin ATM. Relative lipophilicities and structuralpharmacological considerations of various angiotensin-converting enzyme (ACE) inhibitors. Pharm Res 1992; 9: 1480–6.
7. DeForrest JM, Waldron TL, Krapcho J et al. Preclinical pharmacology of zofenopril, an inhibitor of angiotensin I converting enzyme. J Cardiovasc Pharmacol 1989; 13: 887–94.
8. Cushman DW, Wang FL, Fung WC et al. Comparisons in vitro, ex vivo, and in vivo of the actions of seven structurally diverse inhibitors of angiotensin converting enzyme (ACE). Br J Clin Pharmacol 1989; 28: 115S–131S.
9. Ambrosioni E, Borghi C, Magnani B. The effect of the angiotensinconverting– enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. The Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators. N Engl J Med 1995; 332 (2): 80–5.
10. Liu X, Engelman RM, Rousou GA et al. Attenuation of myocardial reperfusion injury by sulfhydryl-containing angiotensin converting enzyme inhibitors. Cardiovasc Drugs Ther 1992; 6 (4): 437–43.
11. Evangelista S, Manzini S. Antioxidant and cardioprotective properties of the sulphydryl angiotensinconverting enzyme inhibitor zofenopril. J Int Med Res 2005; 33 (1): 42–54.
12. Napoli C, Bruzzese G, Ignarro LJ et al. Long-term treatment with sulfhydryl angiotensin–converting enzyme inhibition reduces carotid intima-media thickening and improves the nitric oxide/oxidative stress pathways in newly diagnosed patients with mild to moderate primary hypertension. Am Heart J 2008; 156 (6): 1154 e1–8.
13. Bucci M, Roviezzo F, Brancaleone V, et al. ACE–inhibition ameliorates vascular reactivity and delays diabetes outcome in NOD mice. Vascul Pharmacol 2008; 49 (2–3): 84–90.
14. Ambrosioni E, Borghi C, Magnani B. The effect of the angiotensinconverting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. The Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators. N Engl J Med 1995; 332 (2): 80–5.
15. Borghi C, Bacchelli S, Esposti DD et al. Effects of the administration of an angiotensin–converting enzyme inhibitor during the acute phase of myocardial infarction in patients with arterial hypertension. SMILE Study Investigators. Survival of Myocardial Infarction Long-term Evaluation. Am J Hypertens 1999; 2: 665–72.
16. Borghi C, Bacchelli S, Esposti DD et al. SMILE Study. Effects of the early ACE inhibition in diabetic nonthrombolyzed patients with anterior acute myocardial infarction. Diabetes Care 2003; 26: 1862–8.
17. Borghi C, Ambrosioni E, Survival of Myocardial Infarction Long-term Evaluation-2 Working PartyDouble-blind comparison between zofenopril and lisinopril in patients with acute myocardial infarction: results of the Survival of Myocardial Infarction Long-term Evaluation-2 (SMILE-2) study. Am Heart J 2003; 45: 80–7.
18. Claudio Borghi, MD, and Ettore Ambrosioni, MD, on behalf of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) Study Group Bologna, Italy. Am Heart J 2007; 153: 445. e7244. e14.
19. Malacco E. Clin Drug Invest 2005; 25 (3): 175–82.
Авторы
Н.А.Ваулин
Городская клиническая больница №29 им. Баумана, Москва
vau@medi.ru
Городская клиническая больница №29 им. Баумана, Москва
vau@medi.ru
________________________________________________
N.A.Vaulin
Bauman City Clinical Hospital Twenty-Nine, Moscow
vau@medi.ru
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