Диуретические лекарственные средства широко распространены в клинической практике для лечения артериальной гипертензии. Наибольшее распространение в широкой клинической практике имеют тиазидные (тиазидоподобные) и петлевые диуретики. В статье рассматриваются вопросы рационального выбора диуретиков с учетом имеющейся на сегодня доказательной базы, вопросы лекарственного взаимодействия и контроля эффективности и безопасности терапии. Особое внимание уделяется торасемиду, петлевому диуретику, рекомендованному для долгосрочной фармакотерапии артериальной гипертензии.
Diuretics are widely used in clinical practice in the treatment of arterial hypertension. The thiazide (thiazide-type) and loop diuretics are widely used in general clinical practice. The article deals with the questions of rational choice of diuretics, using the available evidence-based data, the results of drug interaction and the monitoring of efficacy and safety of the therapy. The special attention is paid to torasemide – loop diuretic, which is recommended for long-term pharmacotherapy of arterial hypertension.
Key words: arterial hypertension, pharmacotherapy, the treatment of arterial hypertension, antihypertensive therapy, antihypertensive drugs, diuretics,
thiazide diuretic, thiazide-type diuretics, hydrochlorothiazide, indapamide, loop diuretics, drug interaction, torasemide.
1. 2013 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 (7): 1281–357.
2. Рекомендации по лечению артериальной гипертонии. ESH/ESC 2013. Рос. кардиол. журн. 2014; 1 (105): 7–94. / Rekomendatsii po lecheniiu arterial'noi gipertonii. ESH/ESC 2013. Ros. kardiol. zhurn. 2014; 1 (105): 7–94. [in Russian]
3. Go AS, Bauman MA, Sallyann M et al. AHA/ACC/CDC Science Advisory An Effective Approach to High Blood Pressure Control. Hypertension 2013; 21: 32–4.
4. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAM 2014; 311 (5): 507–20. Doi:10.1001/Jama.2013.284427.
5. Леонова М.В., Штейнберг Л.Л., Белоусов Ю.Б. и др. Результаты фармакоэпидемиологического исследования артериальной гипертонии Пифагор IV: приверженность врачей. Рос. кардиол. журн. 2015; 1 (117): 59–66; http://dx.doi.org/10.15829/1560-4071-2015-1-59-66 / Leonova M.V., Shteinberg L.L., Belousov Iu.B. i dr. Rezul'taty farmakoepidemiologicheskogo issledovaniia arterial'noi gipertonii Pifagor IV: priverzhennost' vrachei. Ros. kardiol. zhurn. 2015; 1 (117): 59–66; http://dx.doi.org/10.15829/1560-4071-2015-1-59-66 [in Russian]
6. Juaquerto DC, Schini VB, Vanhoutte PM. Indapamide potentiates the endothelium-depend production of cyclic guanosine monophosphate by bradykinine in the canine femoral artery. Am Heart J 1991; 122 (2): 1204–9.
7. Gosse Ph, Sheridan D, Zannad F et al. Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5 mg versus enalapril 20 mg: the LIVE Study. J Hypertension 2000; 18: 1465–75.
8. Marre M, Garcia-Puig J, Kokot F et al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR study. J Hypertension 2004; 22: 1613–22.
9. Тhe HYVET Study Group. Treatment of Hypertension in Patients 80 Years of Age or Older. N Engl J Med 2008; 358.
10. Weidmann P. Metabolic profile of indapamide sustained-release in patients with hypertension. Drug Safety 2001; 24: 1155–65.
11. Kostis JB, Wilson AC, Fruedenberger RS. Long term effect of diuretic based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes. Am J Cardiol 2005; 95: 29–35.
12. Marre M, Garcia-Puig J, Kokot F et al. Efficacy of indapamide SR compared with enalapril in elderly hypertensive patients with type 2 diabetes. Am J Hypertension 2007; 20: 90–7.
13 Weidmann P. Metabolic profile of indapamide sustained-release in patients with hypertension. Drugs Safety 2001; 24: 1155–65.
14. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979; 242: 2562–71.
15. Multiple Risk Factor Intervention Trial Research Group. Circulation. 1990; 82: 1616–28.
16. SHEP Cooperative Research Group. JAMA 1991; 265: 3255–64.
17. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002; 288: 2981–97.
18. Carter B et al. Hypertension 2004; 43: 4–9.
19. Calhoun D et al. Circulation 2008; 117: e510–e526.
20. Bakris G et al. J Clin Hypertens (Greenwich) 2008; 10: 707–13.
21. NICE clinical guideline. Clinical management of primary hypertension in adults. 2011. http://www.nice.org.uk/guidance/cg127/chapter/1-guidance
22. Peters R, Beckett N, Forette F et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol 2008; 7: 683–9.
23. Тhe HYVET Study Group. Treatment of Hypertension in Patients 80 Years of Age or Older. N Engl J Med 2008; 358.
24. Морозова Т.Е. Артериальная гипертония у пожилых: особенности течения и выбор терапии. Consilium Medicum. 2012; 14 (5): 12–6. / Morozova T.E. Arterial'naia gipertoniia u pozhilykh: osobennosti techeniia i vybor terapii. Consilium Medicum. 2012; 14 (5): 12–6. [in Russian]
25. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33: 1787–847.
26. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность. 2013; 14; 7. / Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Serdechnaia nedostatochnost'. 2013; 14; 7. [in Russian]
27. De la Sierra A, Segura J, Banegas JR et al. Clinical Features of 8295 Patients With Resistant Hypertension Classified on the Basis of Ambulatory Blood Pressure Monitoring. Hypertension 2011; 57: 898–902.
28. Taler SJ, Textor SC, Augustine JE. Resistant hypertension: comparing hemodynamic management to specialist care. Hypertension 2002; 39: 982–8.
29. Brater DC, Leinfelder J, Anderson SA. Clinical pharmacology of torasemide, a new loop diuretic. Clin Pharmacol Ther 1987; 42: 187–92.
30. Masereel B, Ferrari P, Ferrandi M et al. Na+,2Cl–,K+ cotransport system as a marker of antihypertensive activity of new torasemide derivatives. Eur J Pharmacol 1992; 4; 219 (3): 385–94.
31. Spieker C, Zidek W, Hacker W et al. Assessment of intracellular sodium and calcium in essential hypertension during diuretic treatment. Arzneimittelforschung 1988; 38 (1A): 188–90.
32. Yamanaga K, Uchida T, Kido H et al. But not frusemide, increases intracellular cAMP and cGMP content in the aorta of the renal hypertensive rat. J Pharm Pharmacol 1992; 44 (1): 64–5.
33. Карпов Ю.А. Торасемид: рекомендации для клинического применения при хронической сердечной недостаточности и артериальной гипертензии. Рос. мед. журн. 2014; 23: 1676–80. / Karpov Iu.A. Torasemid: rekomendatsii dlia klinicheskogo primeneniia pri khronicheskoi serdechnoi nedostatochnosti i arterial'noi gipertenzii. Ros. med. zhurn. 2014; 23: 1676–80. [in Russian]
34. Жиров И.В. Место петлевых диуретиков в современных стандартах лечения ХСН. РМЖ. 2012; 25: 1298–304. / Zhirov I.V. Mesto petlevykh diuretikov v sovremennykh standartakh lecheniia KhSN. RMZh. 2012; 25: 1298–304. [in Russian]
35. Cosin J, Diez J. TORIC investigators. Torasemide in chronic heart failure: Results of the TORIC study. Eur J Heart Fail 2002; 4: 507–13.
36. Muller K, Gamba G, Jaquet F, Hess B. Torasemide vs furosemide in primary care patients with chronic heart failure NYHA II to IV – Efficacy and quality of life. Eur J Heart Fail 2003; 5: 793–801.
37. Lopez B, Querejeta R, Gonzalez A et al. Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure. J Am Coll Cardiol 2004; 2; 43 (11): 2028–35.
38. TORAFIC Investigators Group. Effects of prolonged–release torasemide versus furosemide on myocardial fibrosis in hypertensive patients with chronic heart failure: a randomized, blinded-end point, active-controlled study. Clin Ther 2011; 33 (9): 1204–13.
39. Жиров И.В., Горюнова Т.В., Осмоловская Ю.Ф., Терещенко С.Н. Торасемид пролонгированного высвобождения у пациентов с хронической сердечной недостаточностью. Эффективная фармакотерапия. Кардиология и ангиология. 2014; 3 (25): 18–24. / Zhirov I.V., Goriunova T.V., Osmolovskaia Iu.F., Tereshchenko S.N. Torasemid prolongirovannogo vysvobozhdeniia u patsientov s khronicheskoi serdechnoi nedostatochnost'iu. Effektivnaia farmakoterapiia. Kardiologiia i angiologiia. 2014; 3 (25): 18–24. [in Russian]
40. Achhammer I, Metz P. Low dose loop diuretics in essential hypertension. Experience with torasemide. Drugs 1991; 41 (Suppl. 3): 80–91.
41. Гиляревский С.Р., Орлов В.А., Кузьмина И.М., Голшмид М.В. Может ли торасемид пролонгированного действия стать альтернативой тиазидным диуретикам при артериальной гипертонии? Мнение эксперта. Рос. мед. журн. 2012; 20: 1038–43./ Giliarevskii S.R., Orlov V.A., Kuz'mina I.M., Golshmid M.V. Mozhet li torasemid prolongirovannogo deistviia stat' al'ternativoi tiazidnym diuretikam pri arterial'noi gipertonii? Mnenie eksperta. Ros. med. zhurn. 2012; 20: 1038–43. [in Russian]
42. Ткачева О.Н., Рунихина Н.К., Шарашкина Н.В. Торасемид: дополнительные преимущества применения при артериальной гипертензии у женщин в постменопаузе. Системные гипертензии. 2013; 2: 9–13. / Tkacheva O.N., Runikhina N.K., Sharashkina N.V. Torasemide: additional benefits for postmenopausal women with arterial hypertension. System Hypertension. 2013; 2: 9–13. [in Russian]
43. Achhammer I, Eberhard R. Comparison of serum potassium levels during long-term treatment of hypertension patients with 2,5 mg torasemide o.d. or 50 mg triamterene/25 mg hydrochlorothiazide o.d. Prog Pharmaco. Clin Pharmacol 1990; 8: 211–20.
44. Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension. Cardiovasc Drugs Ther 1993; 7 (Suppl. 1): 63–8.
45. Coca A. Long-term blood pressure control and metabolic disorders induced by torasemide in hypertension. Am J Hypertens 2001; 14: 116A.
46. Агеев Ф.Т., Жубрина Е.С., Середенина Е.М. и др. Сравнительная эффективность и безопасность длительного применения торасемида и фуросемида у больных с компенсированной сердечной недостаточностью. Влияние на маркеры фиброза миокарда. Сердечная недостаточность. 2013; 14 (2): 55–62. / Ageev F.T., Zhubrina E.S., Seredenina E.M. i dr. Sravnitel'naia effektivnost' i bezopasnost' dlitel'nogo primeneniia torasemida i furosemida u bol'nykh s kompensirovannoi serdechnoi nedostatochnost'iu. Vliianie na markery fibroza miokarda. Serdechnaia nedostatochnost'. 2013; 14 (2): 55–62. [in Russian]
________________________________________________
1. 2013 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 (7): 1281–357.
2. Rekomendatsii po lecheniiu arterial'noi gipertonii. ESH/ESC 2013. Ros. kardiol. zhurn. 2014; 1 (105): 7–94. [in Russian]
3. Go AS, Bauman MA, Sallyann M et al. AHA/ACC/CDC Science Advisory An Effective Approach to High Blood Pressure Control. Hypertension 2013; 21: 32–4.
4. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAM 2014; 311 (5): 507–20. Doi:10.1001/Jama.2013.284427.
5. Leonova M.V., Shteinberg L.L., Belousov Iu.B. i dr. Rezul'taty farmakoepidemiologicheskogo issledovaniia arterial'noi gipertonii Pifagor IV: priverzhennost' vrachei. Ros. kardiol. zhurn. 2015; 1 (117): 59–66; http://dx.doi.org/10.15829/1560-4071-2015-1-59-66 [in Russian]
6. Juaquerto DC, Schini VB, Vanhoutte PM. Indapamide potentiates the endothelium-depend production of cyclic guanosine monophosphate by bradykinine in the canine femoral artery. Am Heart J 1991; 122 (2): 1204–9.
7. Gosse Ph, Sheridan D, Zannad F et al. Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5 mg versus enalapril 20 mg: the LIVE Study. J Hypertension 2000; 18: 1465–75.
8. Marre M, Garcia-Puig J, Kokot F et al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR study. J Hypertension 2004; 22: 1613–22.
9. Тhe HYVET Study Group. Treatment of Hypertension in Patients 80 Years of Age or Older. N Engl J Med 2008; 358.
10. Weidmann P. Metabolic profile of indapamide sustained-release in patients with hypertension. Drug Safety 2001; 24: 1155–65.
11. Kostis JB, Wilson AC, Fruedenberger RS. Long term effect of diuretic based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes. Am J Cardiol 2005; 95: 29–35.
12. Marre M, Garcia-Puig J, Kokot F et al. Efficacy of indapamide SR compared with enalapril in elderly hypertensive patients with type 2 diabetes. Am J Hypertension 2007; 20: 90–7.
13 Weidmann P. Metabolic profile of indapamide sustained-release in patients with hypertension. Drugs Safety 2001; 24: 1155–65.
14. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979; 242: 2562–71.
15. Multiple Risk Factor Intervention Trial Research Group. Circulation. 1990; 82: 1616–28.
16. SHEP Cooperative Research Group. JAMA 1991; 265: 3255–64.
17. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002; 288: 2981–97.
18. Carter B et al. Hypertension 2004; 43: 4–9.
19. Calhoun D et al. Circulation 2008; 117: e510–e526.
20. Bakris G et al. J Clin Hypertens (Greenwich) 2008; 10: 707–13.
21. NICE clinical guideline. Clinical management of primary hypertension in adults. 2011. http://www.nice.org.uk/guidance/cg127/chapter/1-guidance
22. Peters R, Beckett N, Forette F et al. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol 2008; 7: 683–9.
23. Тhe HYVET Study Group. Treatment of Hypertension in Patients 80 Years of Age or Older. N Engl J Med 2008; 358.
24. Morozova T.E. Arterial'naia gipertoniia u pozhilykh: osobennosti techeniia i vybor terapii. Consilium Medicum. 2012; 14 (5): 12–6. [in Russian]
25. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33: 1787–847.
26. Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Serdechnaia nedostatochnost'. 2013; 14; 7. [in Russian]
27. De la Sierra A, Segura J, Banegas JR et al. Clinical Features of 8295 Patients With Resistant Hypertension Classified on the Basis of Ambulatory Blood Pressure Monitoring. Hypertension 2011; 57: 898–902.
28. Taler SJ, Textor SC, Augustine JE. Resistant hypertension: comparing hemodynamic management to specialist care. Hypertension 2002; 39: 982–8.
29. Brater DC, Leinfelder J, Anderson SA. Clinical pharmacology of torasemide, a new loop diuretic. Clin Pharmacol Ther 1987; 42: 187–92.
30. Masereel B, Ferrari P, Ferrandi M et al. Na+,2Cl–,K+ cotransport system as a marker of antihypertensive activity of new torasemide derivatives. Eur J Pharmacol 1992; 4; 219 (3): 385–94.
31. Spieker C, Zidek W, Hacker W et al. Assessment of intracellular sodium and calcium in essential hypertension during diuretic treatment. Arzneimittelforschung 1988; 38 (1A): 188–90.
32. Yamanaga K, Uchida T, Kido H et al. But not frusemide, increases intracellular cAMP and cGMP content in the aorta of the renal hypertensive rat. J Pharm Pharmacol 1992; 44 (1): 64–5.
33. Karpov Iu.A. Torasemid: rekomendatsii dlia klinicheskogo primeneniia pri khronicheskoi serdechnoi nedostatochnosti i arterial'noi gipertenzii. Ros. med. zhurn. 2014; 23: 1676–80. [in Russian]
34. Zhirov I.V. Mesto petlevykh diuretikov v sovremennykh standartakh lecheniia KhSN. RMZh. 2012; 25: 1298–304. [in Russian]
35. Cosin J, Diez J. TORIC investigators. Torasemide in chronic heart failure: Results of the TORIC study. Eur J Heart Fail 2002; 4: 507–13.
36. Muller K, Gamba G, Jaquet F, Hess B. Torasemide vs furosemide in primary care patients with chronic heart failure NYHA II to IV – Efficacy and quality of life. Eur J Heart Fail 2003; 5: 793–801.
37. Lopez B, Querejeta R, Gonzalez A et al. Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure. J Am Coll Cardiol 2004; 2; 43 (11): 2028–35.
38. TORAFIC Investigators Group. Effects of prolonged–release torasemide versus furosemide on myocardial fibrosis in hypertensive patients with chronic heart failure: a randomized, blinded-end point, active-controlled study. Clin Ther 2011; 33 (9): 1204–13.
39. Zhirov I.V., Goriunova T.V., Osmolovskaia Iu.F., Tereshchenko S.N. Torasemid prolongirovannogo vysvobozhdeniia u patsientov s khronicheskoi serdechnoi nedostatochnost'iu. Effektivnaia farmakoterapiia. Kardiologiia i angiologiia. 2014; 3 (25): 18–24. [in Russian]
40. Achhammer I, Metz P. Low dose loop diuretics in essential hypertension. Experience with torasemide. Drugs 1991; 41 (Suppl. 3): 80–91.
41. Giliarevskii S.R., Orlov V.A., Kuz'mina I.M., Golshmid M.V. Mozhet li torasemid prolongirovannogo deistviia stat' al'ternativoi tiazidnym diuretikam pri arterial'noi gipertonii? Mnenie eksperta. Ros. med. zhurn. 2012; 20: 1038–43. [in Russian]
42. Tkacheva O.N., Runikhina N.K., Sharashkina N.V. Torasemide: additional benefits for postmenopausal women with arterial hypertension. System Hypertension. 2013; 2: 9–13. [in Russian]
43. Achhammer I, Eberhard R. Comparison of serum potassium levels during long-term treatment of hypertension patients with 2,5 mg torasemide o.d. or 50 mg triamterene/25 mg hydrochlorothiazide o.d. Prog Pharmaco. Clin Pharmacol 1990; 8: 211–20.
44. Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension. Cardiovasc Drugs Ther 1993; 7 (Suppl. 1): 63–8.
45. Coca A. Long-term blood pressure control and metabolic disorders induced by torasemide in hypertension. Am J Hypertens 2001; 14: 116A.
46. Ageev F.T., Zhubrina E.S., Seredenina E.M. i dr. Sravnitel'naia effektivnost' i bezopasnost' dlitel'nogo primeneniia torasemida i furosemida u bol'nykh s kompensirovannoi serdechnoi nedostatochnost'iu. Vliianie na markery fibroza miokarda. Serdechnaia nedostatochnost'. 2013; 14 (2): 55–62. [in Russian]
Авторы
Т.Е.Морозова*, И.Ю.Юдина
ГБОУ ВПО Первый Московский государственный медицинский университет им И.М.Сеченова. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*temorozova@gmail.com
________________________________________________
T.E.Morozova*, I.Yu.Yudina
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. 2
*temorozova@gmail.com