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Поражение сердца при артериальной гипертензии. Методы воздействия на гипертензию и сократительную дисфункцию
Поражение сердца при артериальной гипертензии. Методы воздействия на гипертензию и сократительную дисфункцию
Гуревич М.А., Кузьменко Н.А. Поражение сердца при артериальной гипертензии. Методы воздействия на гипертензию и сократительную дисфункцию. Consilium Medicum. 2017; 19 (1): 88–92.
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Аннотация
В обзоре на основании данных литературы и многолетних собственных представлений подробно описаны современные сведения о поражении сердечно-сосудистой системы при гипертонической болезни. Обоснованы клиническое и прогностическое значение гипертрофии левого желудочка при артериальной гипертензии (АГ) на основании данных эхокардиографии и электрокардиографии. Прогрессирование АГ у пожилых значительно осложняется сопутствующими заболеваниями – ишемической болезнью сердца, сахарным диабетом, гипертрофией левого желудочка и др. Терапия больных АГ, кроме снижения артериального давления, требует уменьшения массы миокарда левого желудочка, профилактики хронической сердечной недостаточности. Патогенетическое значение имеют препараты, снижающие активность ренин-антиотензин-альдостероновой системы – ингибиторы ангиотензинпревращающего фермента, сартаны, антагонисты кальция. Кандесартан отличает прочность связывания с АТ1-рецепторами, медленная диссоциация из связи с ними и повторное связывание, что клинически проявляется выраженным и длительным антигипертензивным действием и, среди прочего, обеспечивает контроль утреннего систолического и диастолического артериального давления.
Ключевые слова: артериальная гипертензия, гипертрофия левого желудочка, дисфункция миокарда, сердечная недостаточность, ИАПФ, сартаны, диуретики, антагонисты кальция, кандесартан.
Key words: arterial hypertension, left ventricular hypertrophy, myocardial dysfunction, heart failure, angiotensin-converting enzyme inhibitors, sartans, diuretics, calcium channel blockers.
Ключевые слова: артериальная гипертензия, гипертрофия левого желудочка, дисфункция миокарда, сердечная недостаточность, ИАПФ, сартаны, диуретики, антагонисты кальция, кандесартан.
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The review, based on the data of literature and long-term own studies, shows modern data, concerning the CVS damage in patients with hypertensive disease. The authors demonstrate the clinical and prognostic factors of left ventricle myocardial hypertrophy (LVH) in patients with arterial hypertension (AH) according to the data of echocardiography and electrocardiography. The progression of AH in the elderly is significantly complicated by concomitant diseases: ischaemic heart disease, diabetes mellitus, LVH, etc. The treatment of patients with AH is not associated only with lowering blood pressure but also call for left ventricular mass reduction as a prevention of chronic heart failure. Such drugs as angiotensin-converting enzyme inhibitors, sartans and calcium channel blockers have pathogenetic significance, associated with inhibition of the activity of the renin–angiotensin–aldosterone system. Candesartan is distinguished by the strength of АТ1 receptor binding, slow dissociation and rebinding and has a clinically stable long-term antihypertensive effect. Candesartan helps controlling both morning systolic and diastolic BP.
Key words: arterial hypertension, left ventricular hypertrophy, myocardial dysfunction, heart failure, angiotensin-converting enzyme inhibitors, sartans, diuretics, calcium channel blockers.
Полный текст
Список литературы
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2. Levy D, Garrison RJ, Savage DD et al. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 1989; 110 (2): 101–7.
3. Verdecchia P, Porcellati C, Reboldi G et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 2001; 104 (17): 2039–44.
4. Danlof B, Devereux RB, Kieldsen SE et al, for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
5. Olsen MH, Wachtell K, Hermann KL et al. Is cardiovascular remodeling in patients with essential hypertension related to more than high blood pressure? A LIFE substudy. Losartan Intervention For Endpoint-Reduction in Hypertension. Am Heart J 2002; 144 (3): 530–7.
6. Post WS, Larson MG, Levy D. Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study. Circulation 1994; 90 (1): 179–85.
7. Appel LJ, Stason WB. Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med 1993; 118 (11): 867–82.
8. Wachtell K, Dahlöf B, Rokkedal J et al. Change of left ventricular geometric pattern after 1 year of antihypertensive treatment: the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Am Heart J 2002; 144 (6): 1057–64.
9. Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiology 1986; 57: 450–8.
10. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J 1991; 121 (3 Pt 1): 951–7.
11. Кушаковский М.С. Гипертоническая болезнь . СПб.: Гиппократ, 1995. / Kushakovskii M.S. Gipertonicheskaia bolezn'. SPb.: Gippokrat, 1995. [in Russian]
12. Levy D, Larson MG, Vasan RS et al. The progression from hypertension to congestive heart failure. JAMA 1996; 275 (20): 1557–62.
13. Гогин Е. Е. Гипертоническая болезнь. М., 1997. / Gogin E.E. Gipertonicheskaia bolezn'. M., 1997. [in Russian]
14. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21 (6): 1011–53.
15. Sica DA, Weber M. The Losartan Intervention for Endpoint Reduction (LIFE) trial-have angiotensin-receptor blockers come of age? J Clin Hypertens (Greenwich) 2002; 4 (4): 301–5.
16. De Luca N, Safar ME. Efficacy of a very-low-dose perindopril 2 mg/ indapamide 0,625 mg on cardiac hypertrophy in hypertensive patients. J Hypertens 2002; 20 (4).
17. Spratt J, Shiels A, Williams B et al. On behalf of the LVH study group. Effects of candesartan cilexetil on left ventricular and arterial structure and function in hypertensive patients. J Hypertens 2000; 18 (Suppl. 2): S188.
18. Dahlof B. The PICXEL study benefits of a low dose combination on left ventricular hypertrophy reduction. XIV European Meeting on Hypertension, Paris, 2004.
19. McClellan KJ, Goa KL. Candesartan cilexetil. A review of its use in essential hypertension. Drugs 1998; 56: 847–69.
20. Minatoguchi S, Aoyama Т, Kawai N et a. Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate. Blood Press 2013; 22 (l): 29–37.
21. Cuspidi C, Muiesan ML, Valagussa L еt al. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertension: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J Hypertens 2002; 20: 2293–300.
22. Pfeffer MA, Swedberg K, Granger CB et al. For the CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759–66.
23. Easthope SE, Jarvis B. Candesartan cilexetil: an update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
2. Levy D, Garrison RJ, Savage DD et al. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 1989; 110 (2): 101–7.
3. Verdecchia P, Porcellati C, Reboldi G et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 2001; 104 (17): 2039–44.
4. Danlof B, Devereux RB, Kieldsen SE et al, for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
5. Olsen MH, Wachtell K, Hermann KL et al. Is cardiovascular remodeling in patients with essential hypertension related to more than high blood pressure? A LIFE substudy. Losartan Intervention For Endpoint-Reduction in Hypertension. Am Heart J 2002; 144 (3): 530–7.
6. Post WS, Larson MG, Levy D. Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study. Circulation 1994; 90 (1): 179–85.
7. Appel LJ, Stason WB. Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med 1993; 118 (11): 867–82.
8. Wachtell K, Dahlöf B, Rokkedal J et al. Change of left ventricular geometric pattern after 1 year of antihypertensive treatment: the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Am Heart J 2002; 144 (6): 1057–64.
9. Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiology 1986; 57: 450–8.
10. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J 1991; 121 (3 Pt 1): 951–7.
11. Kushakovskii M.S. Gipertonicheskaia bolezn'. SPb.: Gippokrat, 1995. [in Russian]
12. Levy D, Larson MG, Vasan RS et al. The progression from hypertension to congestive heart failure. JAMA 1996; 275 (20): 1557–62.
13. Gogin E.E. Gipertonicheskaia bolezn'. M., 1997. [in Russian]
14. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21 (6): 1011–53.
15. Sica DA, Weber M. The Losartan Intervention for Endpoint Reduction (LIFE) trial-have angiotensin-receptor blockers come of age? J Clin Hypertens (Greenwich) 2002; 4 (4): 301–5.
16. De Luca N, Safar ME. Efficacy of a very-low-dose perindopril 2 mg/ indapamide 0,625 mg on cardiac hypertrophy in hypertensive patients. J Hypertens 2002; 20 (4).
17. Spratt J, Shiels A, Williams B et al. On behalf of the LVH study group. Effects of candesartan cilexetil on left ventricular and arterial structure and function in hypertensive patients. J Hypertens 2000; 18 (Suppl. 2): S188.
18. Dahlof B. The PICXEL study benefits of a low dose combination on left ventricular hypertrophy reduction. XIV European Meeting on Hypertension, Paris, 2004.
19. McClellan KJ, Goa KL. Candesartan cilexetil. A review of its use in essential hypertension. Drugs 1998; 56: 847–69.
20. Minatoguchi S, Aoyama Т, Kawai N et a. Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate. Blood Press 2013; 22 (l): 29–37.
21. Cuspidi C, Muiesan ML, Valagussa L еt al. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertension: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J Hypertens 2002; 20: 2293–300.
22. Pfeffer MA, Swedberg K, Granger CB et al. For the CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759–66.
23. Easthope SE, Jarvis B. Candesartan cilexetil: an update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
2. Levy D, Garrison RJ, Savage DD et al. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 1989; 110 (2): 101–7.
3. Verdecchia P, Porcellati C, Reboldi G et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 2001; 104 (17): 2039–44.
4. Danlof B, Devereux RB, Kieldsen SE et al, for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
5. Olsen MH, Wachtell K, Hermann KL et al. Is cardiovascular remodeling in patients with essential hypertension related to more than high blood pressure? A LIFE substudy. Losartan Intervention For Endpoint-Reduction in Hypertension. Am Heart J 2002; 144 (3): 530–7.
6. Post WS, Larson MG, Levy D. Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study. Circulation 1994; 90 (1): 179–85.
7. Appel LJ, Stason WB. Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med 1993; 118 (11): 867–82.
8. Wachtell K, Dahlöf B, Rokkedal J et al. Change of left ventricular geometric pattern after 1 year of antihypertensive treatment: the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Am Heart J 2002; 144 (6): 1057–64.
9. Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiology 1986; 57: 450–8.
10. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J 1991; 121 (3 Pt 1): 951–7.
11. Кушаковский М.С. Гипертоническая болезнь . СПб.: Гиппократ, 1995. / Kushakovskii M.S. Gipertonicheskaia bolezn'. SPb.: Gippokrat, 1995. [in Russian]
12. Levy D, Larson MG, Vasan RS et al. The progression from hypertension to congestive heart failure. JAMA 1996; 275 (20): 1557–62.
13. Гогин Е. Е. Гипертоническая болезнь. М., 1997. / Gogin E.E. Gipertonicheskaia bolezn'. M., 1997. [in Russian]
14. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21 (6): 1011–53.
15. Sica DA, Weber M. The Losartan Intervention for Endpoint Reduction (LIFE) trial-have angiotensin-receptor blockers come of age? J Clin Hypertens (Greenwich) 2002; 4 (4): 301–5.
16. De Luca N, Safar ME. Efficacy of a very-low-dose perindopril 2 mg/ indapamide 0,625 mg on cardiac hypertrophy in hypertensive patients. J Hypertens 2002; 20 (4).
17. Spratt J, Shiels A, Williams B et al. On behalf of the LVH study group. Effects of candesartan cilexetil on left ventricular and arterial structure and function in hypertensive patients. J Hypertens 2000; 18 (Suppl. 2): S188.
18. Dahlof B. The PICXEL study benefits of a low dose combination on left ventricular hypertrophy reduction. XIV European Meeting on Hypertension, Paris, 2004.
19. McClellan KJ, Goa KL. Candesartan cilexetil. A review of its use in essential hypertension. Drugs 1998; 56: 847–69.
20. Minatoguchi S, Aoyama Т, Kawai N et a. Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate. Blood Press 2013; 22 (l): 29–37.
21. Cuspidi C, Muiesan ML, Valagussa L еt al. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertension: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J Hypertens 2002; 20: 2293–300.
22. Pfeffer MA, Swedberg K, Granger CB et al. For the CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759–66.
23. Easthope SE, Jarvis B. Candesartan cilexetil: an update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
________________________________________________
2. Levy D, Garrison RJ, Savage DD et al. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 1989; 110 (2): 101–7.
3. Verdecchia P, Porcellati C, Reboldi G et al. Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 2001; 104 (17): 2039–44.
4. Danlof B, Devereux RB, Kieldsen SE et al, for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
5. Olsen MH, Wachtell K, Hermann KL et al. Is cardiovascular remodeling in patients with essential hypertension related to more than high blood pressure? A LIFE substudy. Losartan Intervention For Endpoint-Reduction in Hypertension. Am Heart J 2002; 144 (3): 530–7.
6. Post WS, Larson MG, Levy D. Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study. Circulation 1994; 90 (1): 179–85.
7. Appel LJ, Stason WB. Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med 1993; 118 (11): 867–82.
8. Wachtell K, Dahlöf B, Rokkedal J et al. Change of left ventricular geometric pattern after 1 year of antihypertensive treatment: the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Am Heart J 2002; 144 (6): 1057–64.
9. Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiology 1986; 57: 450–8.
10. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J 1991; 121 (3 Pt 1): 951–7.
11. Kushakovskii M.S. Gipertonicheskaia bolezn'. SPb.: Gippokrat, 1995. [in Russian]
12. Levy D, Larson MG, Vasan RS et al. The progression from hypertension to congestive heart failure. JAMA 1996; 275 (20): 1557–62.
13. Gogin E.E. Gipertonicheskaia bolezn'. M., 1997. [in Russian]
14. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21 (6): 1011–53.
15. Sica DA, Weber M. The Losartan Intervention for Endpoint Reduction (LIFE) trial-have angiotensin-receptor blockers come of age? J Clin Hypertens (Greenwich) 2002; 4 (4): 301–5.
16. De Luca N, Safar ME. Efficacy of a very-low-dose perindopril 2 mg/ indapamide 0,625 mg on cardiac hypertrophy in hypertensive patients. J Hypertens 2002; 20 (4).
17. Spratt J, Shiels A, Williams B et al. On behalf of the LVH study group. Effects of candesartan cilexetil on left ventricular and arterial structure and function in hypertensive patients. J Hypertens 2000; 18 (Suppl. 2): S188.
18. Dahlof B. The PICXEL study benefits of a low dose combination on left ventricular hypertrophy reduction. XIV European Meeting on Hypertension, Paris, 2004.
19. McClellan KJ, Goa KL. Candesartan cilexetil. A review of its use in essential hypertension. Drugs 1998; 56: 847–69.
20. Minatoguchi S, Aoyama Т, Kawai N et a. Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate. Blood Press 2013; 22 (l): 29–37.
21. Cuspidi C, Muiesan ML, Valagussa L еt al. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertension: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J Hypertens 2002; 20: 2293–300.
22. Pfeffer MA, Swedberg K, Granger CB et al. For the CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759–66.
23. Easthope SE, Jarvis B. Candesartan cilexetil: an update of its use in essential hypertension. Drugs 2002; 62: 1253–87.
Авторы
М.А.Гуревич*, Н.А.Кузьменко
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф.Владимирского». 129110, Россия, Москва, ул. Щепкина, д. 61/2
*magurevich@mail.ru
ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф.Владимирского». 129110, Россия, Москва, ул. Щепкина, д. 61/2
*magurevich@mail.ru
________________________________________________
M.A.Gurevich*, N.A.Kuzmenko
M.F.Vladimirskiy Moscow regional research clinical institute. 129110, Russian Federation, Moscow, ul. Shchepkina, d. 61/2
*magurevich@mail.ru
M.F.Vladimirskiy Moscow regional research clinical institute. 129110, Russian Federation, Moscow, ul. Shchepkina, d. 61/2
*magurevich@mail.ru
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