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Открываются новые возможности лечения пациентов с высоким сердечно-сосудистым риском
Барышникова Г.А., Чорбинская С.А. Открываются новые возможности лечения пациентов с высоким сердечно-сосудистым риском. Consilium Medicum. 2017; 19 (10): 13–18. DOI: 10.26442/2075-1753_19.10.13-18
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Baryshnikova G.A., Chorbinskaya S.A. New opportunities to treat patients with high cardiovascular risk. Consilium Medicum. 2017; 19 (10): 13–18. DOI: 10.26442/2075-1753_19.10.13-18
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
В настоящее время одним из основных направлений лечения артериальной гипертонии стала комбинированная антигипертензивная терапия, особенно с использованием фиксированных комбинаций (ФК). К числу наиболее эффективных комбинаций антигипертензивных препаратов относится комбинация ингибиторов ангиотензинпревращающего фермента и антагонистов кальция. Поскольку почти у 70% больных выявляется повышение уровня холестерина, целесообразно присоединение к проводимой терапии препаратов из группы статинов. За рубежом в последние годы широко обсуждается создание полипилюли – ФК 3 и более компонентов, воздействующих на разные факторы риска развития сердечно-сосудистых заболеваний. К полипилюле можно отнести ФК, в состав которой входят ингибитор ангиотензинпревращающего фермента лизиноприл, антагонист кальция амлодипин и гиполипидемический препарат из группы статинов розувастатин. Использование данного препарата, как ожидается, позволит повысить приверженность лечению и, соответственно, эффективность терапии больных с высоким сердечно-сосудистым риском.
Ключевые слова: сердечно-сосудистый риск, факторы риска сердечно-сосудистых заболеваний, артериальная гипертония, дислипидемия, гиперхолестеринемия, комбинированная терапия, фиксированные комбинации, лизиноприл, амлодипин, розувастатин, полипилюля, Эквамер.
Ключевые слова: сердечно-сосудистый риск, факторы риска сердечно-сосудистых заболеваний, артериальная гипертония, дислипидемия, гиперхолестеринемия, комбинированная терапия, фиксированные комбинации, лизиноприл, амлодипин, розувастатин, полипилюля, Эквамер.
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At present, combined antihypertensive therapy has become one of the main directions of the treatment of arterial hypertension, especially with the use of fixed combinations (FC). Among the most effective combinations of antihypertensive drugs is a combination of angiotensin-converting enzyme inhibitors and calcium antagonists. Since almost 70% of patients show an increase in cholesterol, it is advisable to join the treatment with drugs from the group of statins. Abroad, in recent years, the creation of a polypyle – FC 3 or more components that affect different risk factors for the development of cardiovascular diseases is widely discussed. To the polypyle can be attributed FC, which includes an inhibitor of the angiotensin-converting enzyme lisinopril, calcium antagonist amlodipine and a lipid-lowering drug from the group of statins rosuvastatin. Use of this drug is expected to increase adherence to treatment and, accordingly, the effectiveness of therapy for patients with high cardiovascular risk.
Key words: cardiovascular risk, risk factors of cardiovascular diseases, arterial hypertension, dyslipidemia, hypercholesterolemia, combination therapy, fixed combinations, lisinopril, amlodipine, rosuvastatin, polypylla, Ekvamer.
Полный текст
Список литературы
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3. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003; 326: 1419–23.
4. Bonaa KH et al the NORVIT Trial Investigators. Homocysteine lowering and cardiovascular events after acute myocardial infarction. NEJM 2006; 354: 1578–88.
5. Danchin N, Cambou JP, Hanania G et al. Impact of combined secondary prevention therapy after myocardial infarction: data from a nationwide French registry. Am Heart J 2005; 150: 1147–53.
6. Castellano JM, Sanz G, Peñalvo JL et al. A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol 2014; 64 (20): 2071–82.
7. Yusuf S, Pais P, Afzal R et al. Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial. Lancet 2009; 373: 1341–51.
8. The Indian Polycap Study (TIPS). 2009.
9. Dudl RJ, Wang MC, Wong M Bellows. Preventing myocardial infarction and stroke with a simplified bundle of cardioprotective medications. Am J Manag Care 2009; 15: e88–e94.
10. Gaziano TA, Opie LH, Weinstein MC. Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet 2006; 368: 679–86.
11. Kumar A, Fonarow GC, Eagle KA et al. Regional and practice variation in adherence to guideline recommendations for secondary and primary prevention among outpatients with atherothrombosis or risk factors in the United States: a report from the REACH Registry. Crit Pathw Cardiol 2009; 8: 104–11.
12. Sever PS, Dahlof B, Poultier NR et al. Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial. Eur Heart J 2006; 27: 2982–8.
13. Morgado M, Rolo S, Macedo AF, Castelo-Branco M. Association of statin therapy with blood pressure control in hypertensive hypercholesterolemic outpatients in clinical practice. J Cardiovasc Dis Res 2011; 2 (1): 44–9.
14. Watanabe K, Izumi T, Miyakita Y et al. Efficacy of amlodipine besilate therapy for variant angina: evaluation by 24-hour Holter monitoring. Cardiovasc Drugs Ther 1993; 7: 923–8.
15. Pitt B, Byington RP, Furberg CD et al. Effect of amlodipin on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000; 102: 1503–10.
16. Dahlof B, Sever PS, Poulter NR et al. Prevention of cardiovascular events with an Antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendrofluazide as required, in Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT–BPLA): a multicentre randomized controlled trial. Lancet 2005; 366: 895–906.
17. Jamerson KA, Weber MA, Bakris GL et al on behalf of the ACCOMPLISH investigators. Benazepril plus amlodipine or hydrochlorotiazide for hypertension in high-risk patients. N Engl J Med 2008; 359: 2417–28.
18. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288 (23): 2981–97.
19. Диагностика и лечение артериальной гипертензии (Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов). М., 2013. / Diagnostika i lechenie arterialnoi gipertenzii (Rekomendatsii Rossiiskogo meditsinskogo obshchestva po arterialnoi gipertonii i Vserossiiskogo nauchnogo obshchestva kardiologov). M, 2013. [in Russian]
20. Рекомендации по диагностике и лечению артериальной гипертонии ESH и ESC. Евразийский кардиол. журн. 2014; 1: 7–76. / Rekomendatsii po diagnostike i lecheniiu arterialnoi gipertonii ESH i ESC. Evraziiskii kardiol. zhurn. 2014; 1: 7–76. [in Russian]
21. Nissen SE, Tuzcu EM, Schoenhagen P et al: REVERSAL Investigators. Effect of intensive compared with moderate lipidlowering therapy on progression of coronary atherosclerosis. A randomized controlled trial. JAMA 2004; 291: 1071–80.
22. Nissen SE, Nicholls SJ, Sipahi I et al: ASTEROID Investigators. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006; 295: 1556–65.
23. Jones PH, Davidson MH, Stein EA et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses. Am J Cardiol 2003; 92: 152–60.
24. Emerging Risk Factors Collaboration: C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet 2010; 375: 132–40.
25. Effectiveness and safety of combined antihypertensive and cholesterol-reducing therapy (lisinopril-amlodipine and rosuvastatin) in high and very high risk patient populations. Cardiologia Hungarica 2015; 45: 71.
26. Галеева З.М., Галявич А.С. Фиксированная комбинация лизиноприла с амлодипином в сочетании с розувастатином у больных гипертонической болезнью и ишемической болезнью сердца. Терапевт. арх. 2014; 9: 71–6. / Galeeva Z.M., Galiavich A.S. Fiksirovannaia kombinatsiia lizinoprila s amlodipinom v sochetanii s rozuvastatinom u bol'nykh gipertonicheskoi bolezn'iu i ishemicheskoi bolezn'iu serdtsa. Terapevt. arkh. 2014; 9: 71–6. [in Russian]
27. Драпкина О.М., Корнеева О.Н., Зятенкова Е.В. и др. Розувастатин у пациентов с артериальной гипертензией и дислипидемией: влияние на микроциркуляцию и свойства пульсовой волны. Лечащий врач. 2013; 3: 1–4. / Drapkina O.M., Korneeva O.N., Ziatenkova E.V. i dr. Rozuvastatin u patsientov s arterial'noi gipertenziei i dislipidemiei: vliianie na mikrotsirkuliatsiiu i svoistva pul'sovoi volny. Lechashchii vrach. 2013; 3: 1–4. [in Russian]
28. Карпов Ю.А., Лялина С.В. Исследование ТРИУМВИРАТ: снижение риска развития сердечно-сосудистых осложнений у больных артериальной гипертонией с помощью трехкомпонентной комбинации антигипертензивных и липидснижающих препаратов. Кардиология. 2015; 55 (9): 10–5. / Karpov Iu.A., Lialina S.V. Issledovanie TRIUMVIRAT: snizhenie riska razvitiia serdechno-sosudistykh oslozhnenii u bol'nykh arterial'noi gipertoniei s pomoshch'iu trekhkomponentnoi kombinatsii antigipertenzivnykh i lipidsnizhaiushchikh preparatov. Kardiologiia. 2015; 55 (9): 10–5. [in Russian]
29. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации, V пересмотр. М., 2012. / Diagnostika i korrektsiia narushenii lipidnogo obmena s tsel'iu profilaktiki i lecheniia ateroskleroza. Rossiiskie rekomendatsii, V peresmotr. M., 2012. [in Russian]
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1. Chazova I.E., Zhernakova Iu.V., Oshchepkova E.V. i dr. Rasprostranennost faktorov riska razvitiia serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bolnykh arterialnoi gipertoniei. Kardiologiia. 2014; 54 (10): 4–12. [in Russian]
2. Chukaeva I.I. Chto takoe priverzhennost k lecheniiu i chto mozhno sdelat dlia ee uluchsheniia (na primere arterialnoi gipertonii). Lechebnoe delo. 2012; 2: 21–6. [in Russian]
3. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003; 326: 1419–23.
4. Bonaa KH et al the NORVIT Trial Investigators. Homocysteine lowering and cardiovascular events after acute myocardial infarction. NEJM 2006; 354: 1578–88.
5. Danchin N, Cambou JP, Hanania G et al. Impact of combined secondary prevention therapy after myocardial infarction: data from a nationwide French registry. Am Heart J 2005; 150: 1147–53.
6. Castellano JM, Sanz G, Peñalvo JL et al. A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol 2014; 64 (20): 2071–82.
7. Yusuf S, Pais P, Afzal R et al. Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial. Lancet 2009; 373: 1341–51.
8. The Indian Polycap Study (TIPS). 2009.
9. Dudl RJ, Wang MC, Wong M Bellows. Preventing myocardial infarction and stroke with a simplified bundle of cardioprotective medications. Am J Manag Care 2009; 15: e88–e94.
10. Gaziano TA, Opie LH, Weinstein MC. Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet 2006; 368: 679–86.
11. Kumar A, Fonarow GC, Eagle KA et al. Regional and practice variation in adherence to guideline recommendations for secondary and primary prevention among outpatients with atherothrombosis or risk factors in the United States: a report from the REACH Registry. Crit Pathw Cardiol 2009; 8: 104–11.
12. Sever PS, Dahlof B, Poultier NR et al. Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial. Eur Heart J 2006; 27: 2982–8.
13. Morgado M, Rolo S, Macedo AF, Castelo-Branco M. Association of statin therapy with blood pressure control in hypertensive hypercholesterolemic outpatients in clinical practice. J Cardiovasc Dis Res 2011; 2 (1): 44–9.
14. Watanabe K, Izumi T, Miyakita Y et al. Efficacy of amlodipine besilate therapy for variant angina: evaluation by 24-hour Holter monitoring. Cardiovasc Drugs Ther 1993; 7: 923–8.
15. Pitt B, Byington RP, Furberg CD et al. Effect of amlodipin on the progression of atherosclerosis and the occurrence of clinical events. Circulation 2000; 102: 1503–10.
16. Dahlof B, Sever PS, Poulter NR et al. Prevention of cardiovascular events with an Antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendrofluazide as required, in Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT–BPLA): a multicentre randomized controlled trial. Lancet 2005; 366: 895–906.
17. Jamerson KA, Weber MA, Bakris GL et al on behalf of the ACCOMPLISH investigators. Benazepril plus amlodipine or hydrochlorotiazide for hypertension in high-risk patients. N Engl J Med 2008; 359: 2417–28.
18. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288 (23): 2981–97.
19. Diagnostika i lechenie arterialnoi gipertenzii (Rekomendatsii Rossiiskogo meditsinskogo obshchestva po arterialnoi gipertonii i Vserossiiskogo nauchnogo obshchestva kardiologov). M, 2013. [in Russian]
20. Rekomendatsii po diagnostike i lecheniiu arterialnoi gipertonii ESH i ESC. Evraziiskii kardiol. zhurn. 2014; 1: 7–76. [in Russian]
21. Nissen SE, Tuzcu EM, Schoenhagen P et al: REVERSAL Investigators. Effect of intensive compared with moderate lipidlowering therapy on progression of coronary atherosclerosis. A randomized controlled trial. JAMA 2004; 291: 1071–80.
22. Nissen SE, Nicholls SJ, Sipahi I et al: ASTEROID Investigators. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006; 295: 1556–65.
23. Jones PH, Davidson MH, Stein EA et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses. Am J Cardiol 2003; 92: 152–60.
24. Emerging Risk Factors Collaboration: C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet 2010; 375: 132–40.
25. Effectiveness and safety of combined antihypertensive and cholesterol-reducing therapy (lisinopril-amlodipine and rosuvastatin) in high and very high risk patient populations. Cardiologia Hungarica 2015; 45: 71.
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Авторы
Г.А.Барышникова*, С.А.Чорбинская
ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ. 121359, Россия, Москва, ул. Маршала Тимошенко, д. 21
*bargalan@mail.ru
ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ. 121359, Россия, Москва, ул. Маршала Тимошенко, д. 21
*bargalan@mail.ru
________________________________________________
G.A.Baryshnikova*, S.A.Chorbinskaya
Central State Medical Academy of the President of the Russian Federation. 121359, Russian Federation, Moscow, ul. Marshala Timoshenko, d. 21
*bargalan@mail.ru
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