Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Профилактика инсульта и деменции у больных высокого риска
Профилактика инсульта и деменции у больных высокого риска
Остроумова О.Д. Профилактика инсульта и деменции у больных высокого риска. Consilium Medicum. 2015; 17 (10): 73–76. DOI:10.26442/2075-1753_2015.10.73-76
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
В статье рассмотрены группы высокого риска развития инсульта у больных артериальной гипертонией (АГ) – пациенты пожилого и старческого возраста, изолированная систолическая АГ, сахарный диабет. Приведены данные современных рекомендаций по антигипертензивной терапии у больных высокого риска для снижения риска инсульта. Подробно рассмотрены результаты исследования Syst-Eur (The Systolic Hypertension in Europe), в котором антагонист кальция нитрендипин ± эналаприл снизил риск развития инсульта и деменции, в том числе новых случаев болезни Альцгеймера.
Ключевые слова: артериальная гипертония, изолированная систолическая артериальная гипертония, инсульт, деменция, пожилой возраст, сахарный диабет, фиксированные комбинации антигипертензивных препаратов, нитрендипин, эналаприл, Энанорм.
Ключевые слова: артериальная гипертония, изолированная систолическая артериальная гипертония, инсульт, деменция, пожилой возраст, сахарный диабет, фиксированные комбинации антигипертензивных препаратов, нитрендипин, эналаприл, Энанорм.
________________________________________________
The article deals with the high-risk of stroke in patients with arterial hypertension (AH) – elderly and senile patients, isolated systolic AH, diabetes mellitus. We show the modern recommendations for antihypertensive therapy in high-risk patients to reduce the risk of stroke. We discuss the results of Syst-Eur trial (The Systolic Hypertension in Europe), in which the calcium antagonist nitrendipine ± enalapril has reduced the risk of stroke and dementia, including new cases of Alzheimer's disease.
Key words: arterial hypertension, isolated systolic hypertension, stroke, dementia, old age, diabetes mellitus, fixed-dose combinations of antihypertensive agents, enalapril, nitrendipine, Enanorm.
Key words: arterial hypertension, isolated systolic hypertension, stroke, dementia, old age, diabetes mellitus, fixed-dose combinations of antihypertensive agents, enalapril, nitrendipine, Enanorm.
Полный текст
Список литературы
1. Смертность населения Российской Федерации, 1998 г. (статистические материалы). М: Минздрав РФ, 2006. / Smertnost' naseleniia Rossiiskoi Federatsii, 1998 g. (statisticheskie materialy). M: Minzdrav RF, 2006. [in Russian]
2. Гусев Е.И., Скворцова В.И., Стаховская Л.В. Проблема инсульта в Российской Федерации: время активных совместных действий. Журн. неврологии и психиатрии. 2007; 8: 4–10. / Gusev E.I., Skvorcova V.I., Stahovskaja L.V. Problema insul'ta v Rossijskoj Federacii: vremja aktivnyh sovmestnyh dejstvij. Zhurn. nevrologii i psihiatrii. 2007; 8: 4–10. [in Russian]
3. Goldstein LB, Bushnell CD, Adams RJ et al. Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. On behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quali. Stroke 2011;42: 517–84.
4. Оганов Р.Г. Профилактическая кардиология: от гипотез к практике. Кардиология. 1999; 2: 4–9. / Oganov R.G. Profilakticheskaja kardiologija: ot gipotez k praktike. Kardiologija. 1999; 2: 4–9. [in Russian]
5. Диагностика и лечение артериальной гипертензии (Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов). Системные гипертензии. 2010; 3: 5–26. / Diagnosis and treatment of arterial hypertension. (Recommendations for the management of arterial hypertension Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
6. He J, Whelton PK. Elevated systolic blood pressure as a risk factor for cardiovascular and renal disease. J Hypertens 1999; 17 (Suppl. 2): 7–13.
7. Amery A, Brixko P, Clement D. Mortality and morbidity results from the European Working Party in High Blood Pressure in the Elderly trial. Lancet 1985; 1349: 54–62.
8. Burt VL, Whelton P, Roccella EJ. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–91. Hypertension 1995; 25: 305–13.
9. MRC Working Party. Medical Research Council trial of treatment of hypertension in older patients. BMJ 1992; 304: 405–12.
10. Сахарный диабет: диагностика, лечение, профилактика. Под ред. акад. РАН И.И.Дедова, чл.-корр. РАН М.В.Шестаковой. М.: Медицинское информационное агентство, 2011; с. 98, 103–8, 124–52. / Sakharnyi diabet: diagnostika, lechenie, profilaktika. Pod red. akad. RAN I.I.Dedova, chl.-korr. RAN M.V.Shestakovoi. M.: Meditsinskoe informatsionnoe agentstvo, 2011; s. 98, 103–8, 124–52. [in Russian]
11. Chair H, Sowers JR. National high blood pressure education program working group report on hypertension in diabetes. Hypertension 1994; 23: 145–58.
12. Шестакова М.В. Сахарный диабет и артериальная гипертония. В руководстве по артериальной гипертонии. Под ред. акад. РАН Е.И.Чазова, чл.-корр. РАН И.Е.Чазовой. М.: Медиа Медика, 2005; с.415–33. / Shestakova M.V. Saharnyj diabet i arterial'naja gipertonija. V rukovodstve po arterial'noj gipertonii. Pod red. akad. RAN E.I.Chazova, chl.-korr. RAN I.E.Chazovoj. M.: Media Medika, 2005; s.415–33. [in Russian]
13. Mancia G, Fagard R, Narkiewicz K et al. ESH/ESC Guidelines for the 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 2013; 31: 1281–357.
14. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
15. Tuomilehto J, Rastenyte D, Birkenhager WH et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension: Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
16. Thijs L, Richart T, De Leeuw PW. Morbidity and mortality on combination versus monotherapy: a posthoc analysis of the Systolic Hypertension in Europe trial. J Hypertens 2010; 28: 865–74.
17. Skoog I, Lernfelt B, Landahl S et al. 15-years longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141–5.
18. Launer LJ, Masaki K, Petrovitch H, Foley D, Havlik RJ. The assotiation between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA 1995; 274: 1846–51.
19. Henderson AS. Dementia. World Health Organization, Geneva, 1994.
20. Marpillat NL, Macquin-Mavier I, Tropeano A-I et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 2013; 31 (6): 1073–82.
21. Forette F, Seux M-L, Staessen JA et al. for the Syst-Eur Investigators. The Prevention of Dementia with Antihypertensive Treatment. New evidence from the Systolic Hypertension (Syst-Eur) Study. Arch Intern Med 2002; 162 (18): 2046–52.
2. Gusev E.I., Skvorcova V.I., Stahovskaja L.V. Problema insul'ta v Rossijskoj Federacii: vremja aktivnyh sovmestnyh dejstvij. Zhurn. nevrologii i psihiatrii. 2007; 8: 4–10. [in Russian]
3. Goldstein LB, Bushnell CD, Adams RJ et al. Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. On behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quali. Stroke 2011;42: 517–84.
4. Oganov R.G. Profilakticheskaja kardiologija: ot gipotez k praktike. Kardiologija. 1999; 2: 4–9. [in Russian]
5. Diagnosis and treatment of arterial hypertension. (Recommendations for the management of arterial hypertension Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
6. He J, Whelton PK. Elevated systolic blood pressure as a risk factor for cardiovascular and renal disease. J Hypertens 1999; 17 (Suppl. 2): 7–13.
7. Amery A, Brixko P, Clement D. Mortality and morbidity results from the European Working Party in High Blood Pressure in the Elderly trial. Lancet 1985; 1349: 54–62.
8. Burt VL, Whelton P, Roccella EJ. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–91. Hypertension 1995; 25: 305–13.
9. MRC Working Party. Medical Research Council trial of treatment of hypertension in older patients. BMJ 1992; 304: 405–12.
10. Sakharnyi diabet: diagnostika, lechenie, profilaktika. Pod red. akad. RAN I.I.Dedova, chl.-korr. RAN M.V.Shestakovoi. M.: Meditsinskoe informatsionnoe agentstvo, 2011; s. 98, 103–8, 124–52. [in Russian]
11. Chair H, Sowers JR. National high blood pressure education program working group report on hypertension in diabetes. Hypertension 1994; 23: 145–58.
12. Shestakova M.V. Saharnyj diabet i arterial'naja gipertonija. V rukovodstve po arterial'noj gipertonii. Pod red. akad. RAN E.I.Chazova, chl.-korr. RAN I.E.Chazovoj. M.: Media Medika, 2005; s.415–33. [in Russian]
13. Mancia G, Fagard R, Narkiewicz K et al. ESH/ESC Guidelines for the 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 2013; 31: 1281–357.
14. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
15. Tuomilehto J, Rastenyte D, Birkenhager WH et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension: Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
16. Thijs L, Richart T, De Leeuw PW. Morbidity and mortality on combination versus monotherapy: a posthoc analysis of the Systolic Hypertension in Europe trial. J Hypertens 2010; 28: 865–74.
17. Skoog I, Lernfelt B, Landahl S et al. 15-years longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141–5.
18. Launer LJ, Masaki K, Petrovitch H, Foley D, Havlik RJ. The assotiation between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA 1995; 274: 1846–51.
19. Henderson AS. Dementia. World Health Organization, Geneva, 1994.
20. Marpillat NL, Macquin-Mavier I, Tropeano A-I et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 2013; 31 (6): 1073–82.
21. Forette F, Seux M-L, Staessen JA et al. for the Syst-Eur Investigators. The Prevention of Dementia with Antihypertensive Treatment. New evidence from the Systolic Hypertension (Syst-Eur) Study. Arch Intern Med 2002; 162 (18): 2046–52.
2. Гусев Е.И., Скворцова В.И., Стаховская Л.В. Проблема инсульта в Российской Федерации: время активных совместных действий. Журн. неврологии и психиатрии. 2007; 8: 4–10. / Gusev E.I., Skvorcova V.I., Stahovskaja L.V. Problema insul'ta v Rossijskoj Federacii: vremja aktivnyh sovmestnyh dejstvij. Zhurn. nevrologii i psihiatrii. 2007; 8: 4–10. [in Russian]
3. Goldstein LB, Bushnell CD, Adams RJ et al. Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. On behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quali. Stroke 2011;42: 517–84.
4. Оганов Р.Г. Профилактическая кардиология: от гипотез к практике. Кардиология. 1999; 2: 4–9. / Oganov R.G. Profilakticheskaja kardiologija: ot gipotez k praktike. Kardiologija. 1999; 2: 4–9. [in Russian]
5. Диагностика и лечение артериальной гипертензии (Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов). Системные гипертензии. 2010; 3: 5–26. / Diagnosis and treatment of arterial hypertension. (Recommendations for the management of arterial hypertension Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
6. He J, Whelton PK. Elevated systolic blood pressure as a risk factor for cardiovascular and renal disease. J Hypertens 1999; 17 (Suppl. 2): 7–13.
7. Amery A, Brixko P, Clement D. Mortality and morbidity results from the European Working Party in High Blood Pressure in the Elderly trial. Lancet 1985; 1349: 54–62.
8. Burt VL, Whelton P, Roccella EJ. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–91. Hypertension 1995; 25: 305–13.
9. MRC Working Party. Medical Research Council trial of treatment of hypertension in older patients. BMJ 1992; 304: 405–12.
10. Сахарный диабет: диагностика, лечение, профилактика. Под ред. акад. РАН И.И.Дедова, чл.-корр. РАН М.В.Шестаковой. М.: Медицинское информационное агентство, 2011; с. 98, 103–8, 124–52. / Sakharnyi diabet: diagnostika, lechenie, profilaktika. Pod red. akad. RAN I.I.Dedova, chl.-korr. RAN M.V.Shestakovoi. M.: Meditsinskoe informatsionnoe agentstvo, 2011; s. 98, 103–8, 124–52. [in Russian]
11. Chair H, Sowers JR. National high blood pressure education program working group report on hypertension in diabetes. Hypertension 1994; 23: 145–58.
12. Шестакова М.В. Сахарный диабет и артериальная гипертония. В руководстве по артериальной гипертонии. Под ред. акад. РАН Е.И.Чазова, чл.-корр. РАН И.Е.Чазовой. М.: Медиа Медика, 2005; с.415–33. / Shestakova M.V. Saharnyj diabet i arterial'naja gipertonija. V rukovodstve po arterial'noj gipertonii. Pod red. akad. RAN E.I.Chazova, chl.-korr. RAN I.E.Chazovoj. M.: Media Medika, 2005; s.415–33. [in Russian]
13. Mancia G, Fagard R, Narkiewicz K et al. ESH/ESC Guidelines for the 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 2013; 31: 1281–357.
14. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
15. Tuomilehto J, Rastenyte D, Birkenhager WH et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension: Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
16. Thijs L, Richart T, De Leeuw PW. Morbidity and mortality on combination versus monotherapy: a posthoc analysis of the Systolic Hypertension in Europe trial. J Hypertens 2010; 28: 865–74.
17. Skoog I, Lernfelt B, Landahl S et al. 15-years longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141–5.
18. Launer LJ, Masaki K, Petrovitch H, Foley D, Havlik RJ. The assotiation between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA 1995; 274: 1846–51.
19. Henderson AS. Dementia. World Health Organization, Geneva, 1994.
20. Marpillat NL, Macquin-Mavier I, Tropeano A-I et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 2013; 31 (6): 1073–82.
21. Forette F, Seux M-L, Staessen JA et al. for the Syst-Eur Investigators. The Prevention of Dementia with Antihypertensive Treatment. New evidence from the Systolic Hypertension (Syst-Eur) Study. Arch Intern Med 2002; 162 (18): 2046–52.
________________________________________________
2. Gusev E.I., Skvorcova V.I., Stahovskaja L.V. Problema insul'ta v Rossijskoj Federacii: vremja aktivnyh sovmestnyh dejstvij. Zhurn. nevrologii i psihiatrii. 2007; 8: 4–10. [in Russian]
3. Goldstein LB, Bushnell CD, Adams RJ et al. Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. On behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quali. Stroke 2011;42: 517–84.
4. Oganov R.G. Profilakticheskaja kardiologija: ot gipotez k praktike. Kardiologija. 1999; 2: 4–9. [in Russian]
5. Diagnosis and treatment of arterial hypertension. (Recommendations for the management of arterial hypertension Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
6. He J, Whelton PK. Elevated systolic blood pressure as a risk factor for cardiovascular and renal disease. J Hypertens 1999; 17 (Suppl. 2): 7–13.
7. Amery A, Brixko P, Clement D. Mortality and morbidity results from the European Working Party in High Blood Pressure in the Elderly trial. Lancet 1985; 1349: 54–62.
8. Burt VL, Whelton P, Roccella EJ. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–91. Hypertension 1995; 25: 305–13.
9. MRC Working Party. Medical Research Council trial of treatment of hypertension in older patients. BMJ 1992; 304: 405–12.
10. Sakharnyi diabet: diagnostika, lechenie, profilaktika. Pod red. akad. RAN I.I.Dedova, chl.-korr. RAN M.V.Shestakovoi. M.: Meditsinskoe informatsionnoe agentstvo, 2011; s. 98, 103–8, 124–52. [in Russian]
11. Chair H, Sowers JR. National high blood pressure education program working group report on hypertension in diabetes. Hypertension 1994; 23: 145–58.
12. Shestakova M.V. Saharnyj diabet i arterial'naja gipertonija. V rukovodstve po arterial'noj gipertonii. Pod red. akad. RAN E.I.Chazova, chl.-korr. RAN I.E.Chazovoj. M.: Media Medika, 2005; s.415–33. [in Russian]
13. Mancia G, Fagard R, Narkiewicz K et al. ESH/ESC Guidelines for the 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 2013; 31: 1281–357.
14. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
15. Tuomilehto J, Rastenyte D, Birkenhager WH et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension: Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
16. Thijs L, Richart T, De Leeuw PW. Morbidity and mortality on combination versus monotherapy: a posthoc analysis of the Systolic Hypertension in Europe trial. J Hypertens 2010; 28: 865–74.
17. Skoog I, Lernfelt B, Landahl S et al. 15-years longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141–5.
18. Launer LJ, Masaki K, Petrovitch H, Foley D, Havlik RJ. The assotiation between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. JAMA 1995; 274: 1846–51.
19. Henderson AS. Dementia. World Health Organization, Geneva, 1994.
20. Marpillat NL, Macquin-Mavier I, Tropeano A-I et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 2013; 31 (6): 1073–82.
21. Forette F, Seux M-L, Staessen JA et al. for the Syst-Eur Investigators. The Prevention of Dementia with Antihypertensive Treatment. New evidence from the Systolic Hypertension (Syst-Eur) Study. Arch Intern Med 2002; 162 (18): 2046–52.
Авторы
О.Д.Остроумова
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127423, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 1
ostroumova.olga@mail.ru
ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127423, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 1
ostroumova.olga@mail.ru
________________________________________________
O.D.Ostroumova
A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia d. 8, str. 1
ostroumova.olga@mail.ru
A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia d. 8, str. 1
ostroumova.olga@mail.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.