Клиническое значение органопротективных свойств антигипертензивных препаратов в новых рекомендациях по артериальной гипертонии: возможности антагонистов кальция и диуретиков
Клиническое значение органопротективных свойств антигипертензивных препаратов в новых рекомендациях по артериальной гипертонии: возможности антагонистов кальция и диуретиков
Кочетков А.И., Остроумова О.Д. Клиническое значение органопротективных свойств антигипертензивных препаратов в новых рекомендациях по артериальной гипертонии: возможности антагонистов кальция и диуретиков. Consilium Medicum. 2019; 21 (5): 11–18. DOI: 10.26442/20751753.2019.5.190417
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Kochetkov A.I., Ostroumova O.D. The clinical implication of the target organ protective properties of antihypertensive drugs in new guidelines for the management of arterial hypertension: the benefit of calcium channel blockers and diuretics. Consilium Medicum. 2019; 21 (5): 11–18. DOI: 10.26442/20751753.2019.5.190417
Клиническое значение органопротективных свойств антигипертензивных препаратов в новых рекомендациях по артериальной гипертонии: возможности антагонистов кальция и диуретиков
Кочетков А.И., Остроумова О.Д. Клиническое значение органопротективных свойств антигипертензивных препаратов в новых рекомендациях по артериальной гипертонии: возможности антагонистов кальция и диуретиков. Consilium Medicum. 2019; 21 (5): 11–18. DOI: 10.26442/20751753.2019.5.190417
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Kochetkov A.I., Ostroumova O.D. The clinical implication of the target organ protective properties of antihypertensive drugs in new guidelines for the management of arterial hypertension: the benefit of calcium channel blockers and diuretics. Consilium Medicum. 2019; 21 (5): 11–18. DOI: 10.26442/20751753.2019.5.190417
На сегодняшний день общепризнанным и доказанным фактом является важнейшая клинико-прогностическая значимость поражения органов, обусловленного артериальной гипертонией (АГ), а также необходимость коррекции этих структурно-функциональных нарушений с помощью антигипертензивных препаратов. В обновленных Европейских и Российских рекомендациях по диагностике и лечению АГ вновь обращается особое внимание на высокую распространенность данного заболевания. Кроме того, в этих документах подчеркивается приоритетность комбинированной антигипертензивной терапии, включающей в себя помимо блокаторов ренин-ангиотензин-альдостероновой системы антагонисты кальция и диуретики как терапии 1-й линии, показанной к назначению большинству пациентов с АГ. В фокусе рекомендаций также находится важность поражения органов-мишеней в качестве фактора, обусловливающего существенное увеличение бремени сердечно-сосудистого риска для пациента и играющего одну из основополагающих прогностических ролей в развитии фатальных и нефатальных осложнений. В этой связи целесообразно указать на мощные органопротективные свойства тиазидоподобного диуретика индапамида и дигидропиридинового антагониста кальция нитрендипина и их уникальные фармакологические свойства, выгодно выделяющие каждый из данных антигипертензивных препаратов внутри своего класса и позволяющие обеспечить защиту всех органов-мишеней АГ. Результаты рандомизированных клинических исследований не только свидетельствуют о способности индапамида и нитрендипина предотвращать развитие поражения органов-мишеней, но и демонстрируют их высокий потенциал в регрессе таких нарушений, вызванных АГ, что в свою очередь позволяет говорить о снижении сердечно-сосудистого риска и улучшении прогноза для пациента на фоне применения данных препаратов и расширяет возможности практикующих врачей в органопротекции при антигипертензивной терапии.
It is well-known and proven that hypertension-mediated organ damage is about high clinical importance and prognostic significance as well as these end-organ structural and functional impairment are required to be reversed or delayed by antihypertensive treatment. Updated European and Russian guidelines for the management of arterial hypertension once again pay attention to the high prevalence of this disease. These documents also emphasize the priority of combination antihypertensive treatment, which includes, in addition to renin-angiotensin-aldosterone system blockers, calcium channel antagonists and diuretics, as a first-line therapy, indicated for the most patients with hypertension. The recommendations also highlight importance of target-organ damage as a factor contributing to an extremely increase in burden of cardiovascular risk for the patient and playing one of the fundamental prognostic roles in the development of fatal and non-fatal cardiovascular events. In this regard, it is reasonable to stress the powerful target-organ protective potential of the thiazide-like diuretic indapamide and the calcium channel blocker nitrendipine and their unique pharmacological properties, which favorably distinguish each of these antihypertensive drugs within their class and are provided the protection of all hypertension end-organs. The data from randomized clinical trials indicate not only the ability of indapamide and nitrendipine to prevent the development of target-organ damage, but also demonstrate their high potential in reversing such impairment caused by hypertension, which in turn suggests a reduction in cardiovascular risk and improved prognosis for patient during using of these drugs and expands the capabilities of physicians in target-organ protection with antihypertensive treatment.
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1. Williams B, Mancia G, Spiering W et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018; 39 (33): 3021–104. DOI: 10.1093/eurheartj/ehy339
2. Chazova I.E., Zhernakova Yu.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16 (1): 6–31. DOI: 10.26442/2075082X.2019.1.190179 (in Russian)
3. Kannel WB. Left ventricular hypertrophy as a risk factor in arterial hypertension. Eur Heart J 1992; 13 (Suppl. D): 82–8. DOI: 10.1093/eurheartj/13.suppl_D.82
4. Stevens SM, Reinier K, Chugh SS. Increased left ventricular mass as a predictor of sudden cardiac death: is it time to put it to the test? Circ: Arrhythmia Electrophysiology 2013; 6 (1): 212–7. DOI: 10.1161/CIRCEP.112.974931
5. Levy D, Garrison RJ, Savage DD et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322: 1561–6. DOI: 10.1056/NEJM199005313222203
6. Koren MJ, Devereux RB, Casale PN et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114: 345–52. DOI: 10.7326/0003-4819-114-5-345
7. Bombelli M, Facchetti R, Carugo S et al. Left ventricular hypertrophy increases cardiovascular risk independently of in-office and out-of-office blood pressure values. J Hypertens 2009; 27 (12): 2458–64. DOI: 10.1097/HJH.0b013e328330b845
8. Bouzas-Mosquera A, Broullón FJ, Álvarez-García N et al. Association of Left Ventricular Mass with All-Cause Mortality, Myocardial Infarction and Stroke. PLoS ONE 2012; 7 (9): e45570. DOI: 10.1371/journal.pone.0045570
9. Nepper-Christensen L, Lønborg J, Ahtarovski KA et al. Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2017; 6 (1). PII: e004823. DOI: 10.1161/JAHA.116.004823
10. De Simone G, Gottdiener JS, Chinali M et al. Left ventricular mass predicts heart failure not related to previous myocardial infarction: the Cardiovascular Health Study. Eur Heart J 2008; 29 (6): 741–7. DOI: 10.1093/eurheartj/ehm605
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Авторы
А.И. Кочетков1, О.Д. Остроумова*1,2
1 ОСП «Российский геронтологический научно-клинический центр» ФГБОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*ostroumova.olga@mail.ru
________________________________________________
Aleksei I. Kochetkov1, Olga D. Ostroumova*1,2
1 Russian Clinical and Research Center of Gerontology, leading department of Pirogov Russian National Research Medical University, Moscow, Russia
2 I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*ostroumova.olga@mail.ru