В обзорной статье представлен анализ основных причин резистентности к антигипертензивной терапии и неконтролируемой артериальной гипертензии. Обсуждается тактика подбора комбинированной антигипертензивной терапии. Рассматриваются преимущества 3-компонентной комбинированной терапии, включающей антагонист кальция амлодипин, ингибитор ангиотензинпревращающего фермента периндоприл и тиазидоподобный диуретик индапамид. Приводится анализ исследований, показывающих эффективность и безопасность фиксированной комбинации амлодипин/индапамид/периндоприл.
In a review article presents an analysis of the main causes of resistance to antihypertensive treatment and uncontrolled arterial hypertension. The article deals with the discussion of the selection of combined antihypertensive treatment. The authors have shown the benefits of 3-component combined therapy consisting of calcium antagonist – amlodipine, angiotensin-converting enzyme inhibitor – perindopril and thiazide-like diuretic – indapamide. The analysis of the study demonstrates the efficacy and safety of fixed dose combination of perindopril/indapamide/amlodipine.
1. Mancia G, Fagard R, Narkiewicz K et al. ESH-ESC Task Force on the Management of Arterial Hypertension. 2013 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2013; 31 (7): 1281–357.
2. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertension 2009; 27: 2121–58.
3. The Task Force for the management of arterial hypertension of the European Society of Hypertension and of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension. J Hypertens 2007; 25: 1105–87.
4. Чазова И.Е. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014; 10: 4–12. / Chazova I.E. i dr. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12. [in Russian]
5. Оганов Р.Г. и др. Эпидемиология артериальной гипертонии в России. Результаты федерального мониторинга 2003–2010 гг. Кардиоваск. терапия и профилактика. 2011; 10 (1): 9–13. / Oganov R.G. i dr. Epidemiologiia arterial'noi gipertonii v Rossii. Rezul'taty federal'nogo monitoringa 2003–2010 gg. Kardiovask. terapiia i profilaktika. 2011; 10 (1): 9–13. [in Russian]
6. Chow CK, Teo KK, Rangarajan S et al. PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310 (9): 959–68.
7. Frohlich ED. Classification of resistant hypertension. Hypertension 1988; 11: 1167–70.
8. Mazzaglia G, Mantovani LG, Sturkenboom MC et al. Pattern of persistence with antihypertensive medication in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care. J Hypertens 2005; 23: 2093–100.
9. Garg JP, Elliot WJ, Folker A et al. RUSH University Hypertension Service. Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens 2005; 18 (5): 619–26.
10. Osterberg L, Blaschke T. Adherence to Medication. N Engl J Med 2005; 353: 487–97.
11. Thoenes M, Neuberger H-R, Volpe M et al. Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. J Hum Hypertens 2010; 24: 336–44.
12. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents, a meta-analysis. Hypertension 2010; 55: 399–407.
13. Johnoston CI, Fabris B, Yamada T. Comparative studies of tissue inhibition by angiotensin converting enzyme inhibitors. J Hypertension Suppl 1989; 7 (5): S11–7.
14. Paul M, Mehr AP, Kreutz R. Physiology of local renin-angiotensin systems. Physiol Rev 2006; 86: 747–803.
15. Ceconi C, Fox KM, Remme WJ et al. ACE inhibition with perindopril and endothelial dysfunction: results of a substudy of the EUROPA study PERTINENT. Cardiovasc Res 2007; 73: 237–46.
16. Rodriguez-Granillo GA. Long-term effect of Perindopril on coronary atherosclerosis progression [from the PERindopril’s Prospective Effect on Coronary aTherosclerosis by Angiography and IntraVascular Ultrasound Evaluation (PERSPECTIVE) Study]. Am J Cardiol 2007; 100: 159–63.
17. Pruss T, Wolf PS. Preclinical studies of indapamide, a new 2methylindoline antihypertensive diuretic. Am Heart J 1983; 106 (1, Pt 2): 208–11.
18. Gosse P, Sheridan DJ, 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 Hypertens 2000; 18: 1465–75.
19. Marre M, Puig JG, Kokot F еt al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR study. J Hypertens 2004; 22: 1613–22.
20. Асташкин Е.И., Глезер М.Г., Петров Е.А. Влияние индапамида на уровень радикалов кислорода, продуцируемых фагоцитами крови пациентов с сердечной недостаточностью. Рос. кардиол. журн. 2012; 4: 43–7. / Astashkin E.I., Glezer M.G., Petrov E.A. Vliianie indapamida na uroven' radikalov kisloroda, produtsiruemykh fagotsitami krovi patsientov s serdechnoi nedostatochnost'iu. Ros. kardiol. zhurn. 2012; 4: 43–7. [in Russian]
21. Hernaґndez RH, Armas-Hernaґndez MJ, Zafar HI, Armas-Padilla MC. Calcium antagonists and atherosclerosis protection in hypertension. Am J Ther 2003; 10 (6): 409–14.
22. Mason RP, Rhodes DG, Herbette LG. Reevaluating equilibrium and kinetic binding parameters for lipophilic drugs based on a structural model for drug interaction with biological membranes. J Med Chem 1991; 34 (3): 869–77.
23. Phillips JE, Mason RP. Inhibition of oxidized LDL aggregation with a charged calcium antagonist amlodipine: role of electrostatic interactions. Atherosclerosis 2003; 168 (2): 239–44.
24. BHS-NICE. Guidelines. Clinical management of primary hypertension in adults 2011. Updated April 2016. http://www.nice.org.uk
25. Toth K. PIANIST Investigators. Antihypertensive efficacy of triple combination plus amlodipine in risk hypertensive patients. Am J Cardiovasc Drugs 2014; 14 (2): 137–45.
26. Páll D, SzántóI, Szabó Z. Triple combination therapy in hypertension: the antihypertensive efficacy of treatment with perindopril, amlodipine, and indapamide SR. Clin Drug Investig 2014; 34: 701–8.
27. Efficiency of the combined treatment of arterial hypertension in Ukraine: results of the TRIUMF multicenter study M.I.Lutay, on behalf of the TRIUMF multicenter study group. Український кардіол. журн. 2016; 4: 17–28.
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1. Mancia G, Fagard R, Narkiewicz K et al. ESH-ESC Task Force on the Management of Arterial Hypertension. 2013 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2013; 31 (7): 1281–357.
2. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertension 2009; 27: 2121–58.
3. The Task Force for the management of arterial hypertension of the European Society of Hypertension and of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension. J Hypertens 2007; 25: 1105–87.
4. Chazova I.E. i dr. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12. [in Russian]
5. Oganov R.G. i dr. Epidemiologiia arterial'noi gipertonii v Rossii. Rezul'taty federal'nogo monitoringa 2003–2010 gg. Kardiovask. terapiia i profilaktika. 2011; 10 (1): 9–13. [in Russian]
6. Chow CK, Teo KK, Rangarajan S et al. PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310 (9): 959–68.
7. Frohlich ED. Classification of resistant hypertension. Hypertension 1988; 11: 1167–70.
8. Mazzaglia G, Mantovani LG, Sturkenboom MC et al. Pattern of persistence with antihypertensive medication in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care. J Hypertens 2005; 23: 2093–100.
9. Garg JP, Elliot WJ, Folker A et al. RUSH University Hypertension Service. Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens 2005; 18 (5): 619–26.
10. Osterberg L, Blaschke T. Adherence to Medication. N Engl J Med 2005; 353: 487–97.
11. Thoenes M, Neuberger H-R, Volpe M et al. Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. J Hum Hypertens 2010; 24: 336–44.
12. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents, a meta-analysis. Hypertension 2010; 55: 399–407.
13. Johnoston CI, Fabris B, Yamada T. Comparative studies of tissue inhibition by angiotensin converting enzyme inhibitors. J Hypertension Suppl 1989; 7 (5): S11–7.
14. Paul M, Mehr AP, Kreutz R. Physiology of local renin-angiotensin systems. Physiol Rev 2006; 86: 747–803.
15. Ceconi C, Fox KM, Remme WJ et al. ACE inhibition with perindopril and endothelial dysfunction: results of a substudy of the EUROPA study PERTINENT. Cardiovasc Res 2007; 73: 237–46.
16. Rodriguez-Granillo GA. Long-term effect of Perindopril on coronary atherosclerosis progression [from the PERindopril’s Prospective Effect on Coronary aTherosclerosis by Angiography and IntraVascular Ultrasound Evaluation (PERSPECTIVE) Study]. Am J Cardiol 2007; 100: 159–63.
17. Pruss T, Wolf PS. Preclinical studies of indapamide, a new 2methylindoline antihypertensive diuretic. Am Heart J 1983; 106 (1, Pt 2): 208–11.
18. Gosse P, Sheridan DJ, 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 Hypertens 2000; 18: 1465–75.
19. Marre M, Puig JG, Kokot F еt al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR study. J Hypertens 2004; 22: 1613–22.
20. Astashkin E.I., Glezer M.G., Petrov E.A. Vliianie indapamida na uroven' radikalov kisloroda, produtsiruemykh fagotsitami krovi patsientov s serdechnoi nedostatochnost'iu. Ros. kardiol. zhurn. 2012; 4: 43–7. [in Russian]
21. Hernaґndez RH, Armas-Hernaґndez MJ, Zafar HI, Armas-Padilla MC. Calcium antagonists and atherosclerosis protection in hypertension. Am J Ther 2003; 10 (6): 409–14.
22. Mason RP, Rhodes DG, Herbette LG. Reevaluating equilibrium and kinetic binding parameters for lipophilic drugs based on a structural model for drug interaction with biological membranes. J Med Chem 1991; 34 (3): 869–77.
23. Phillips JE, Mason RP. Inhibition of oxidized LDL aggregation with a charged calcium antagonist amlodipine: role of electrostatic interactions. Atherosclerosis 2003; 168 (2): 239–44.
24. BHS-NICE. Guidelines. Clinical management of primary hypertension in adults 2011. Updated April 2016. http://www.nice.org.uk
25. Toth K. PIANIST Investigators. Antihypertensive efficacy of triple combination plus amlodipine in risk hypertensive patients. Am J Cardiovasc Drugs 2014; 14 (2): 137–45.
26. Páll D, SzántóI, Szabó Z. Triple combination therapy in hypertension: the antihypertensive efficacy of treatment with perindopril, amlodipine, and indapamide SR. Clin Drug Investig 2014; 34: 701–8.
27. Efficiency of the combined treatment of arterial hypertension in Ukraine: results of the TRIUMF multicenter study M.I.Lutay, on behalf of the TRIUMF multicenter study group. Український кардіол. журн. 2016; 4: 17–28.
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1 *adashtv@mail.ru
A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*adashtv@mail.ru