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Опыт применения фиксированной комбинации рамиприла и индапамида в клинической практике
Кочеткова И.В. Опыт применения фиксированной комбинации рамиприла и индапамида в клинической практике. Consilium Medicum. 2021; 23 (1). DOI: 10.26442/20751753.2021.1.200759
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Kochetkovа I.V. Experience of using a fixed combination of ramipril and indapamide in clinical practice. Consilium Medicum. 2021; 23 (1). DOI: 10.26442/20751753.2021.1.200759
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Аннотация
Актуальность. Артериальная гипертензия – одно из самых распространенных сердечно-сосудистых заболеваний у взрослого населения, однако достигнуто уже многое в его лечении. Преимущества комбинированной терапии, согласно клиническим рекомендациям «Артериальная гипертензия у взрослых» 2020 г., следующие: усиление степени снижения артериального давления (АД) намного сильнее, чем повышение дозы одного препарата; возможность физиологического и фармакологического синергизма между препаратами разных классов, что может лежать в основе более выраженного снижения АД и лучшей переносимости лечения; при комбинированной терапии имеет место подавление разноплановых механизмов повышения АД.
Цель. Изучение влияния гипотензивного препарата Консилар-Д24 на клиническую картину, данные вариабельности ритма сердца, гемодинамические показатели у больных гипертонической болезнью (ГБ) II стадии, АД 2-й степени.
Материалы и методы. Обследованы 40 пациентов с ГБ II стадии, АД 2-й степени. При амбулаторном обследовании всем пациентам проводились оценка вариабельности сердечного ритма, самостоятельного контроля АД, суточного мониторирования АД, эхокардиографии, электрокардиографии, скорости клубочковой фильтрации, лабораторно-биохимическое обследование (общий анализ крови, общий анализ мочи, биохимия крови – креатинин, мочевина, глюкоза, аспартатаминотрансфераза, аланинаминотрансфераза), анкетирование с помощью опросника качества жизни SF-36.
Результаты. Рост средней взвешенной вариации ритмограммы, снижение АД, повышение качества жизни пациента на фоне применения препарата Консилар-Д24. Консилар-Д24 является эффективным гипотензивным средством при АД 2-й степени в комплексном лечении ГБ II стадии. На фоне терапии фиксируются стойкое достижение целевых цифр, повышение вагального тонуса. Отмечается метаболическая нейтральность препарата, а также нефро- и кардиопротективные действия.
Ключевые слова: артериальная гипертензия, рамиприл, индапамид
Цель. Изучение влияния гипотензивного препарата Консилар-Д24 на клиническую картину, данные вариабельности ритма сердца, гемодинамические показатели у больных гипертонической болезнью (ГБ) II стадии, АД 2-й степени.
Материалы и методы. Обследованы 40 пациентов с ГБ II стадии, АД 2-й степени. При амбулаторном обследовании всем пациентам проводились оценка вариабельности сердечного ритма, самостоятельного контроля АД, суточного мониторирования АД, эхокардиографии, электрокардиографии, скорости клубочковой фильтрации, лабораторно-биохимическое обследование (общий анализ крови, общий анализ мочи, биохимия крови – креатинин, мочевина, глюкоза, аспартатаминотрансфераза, аланинаминотрансфераза), анкетирование с помощью опросника качества жизни SF-36.
Результаты. Рост средней взвешенной вариации ритмограммы, снижение АД, повышение качества жизни пациента на фоне применения препарата Консилар-Д24. Консилар-Д24 является эффективным гипотензивным средством при АД 2-й степени в комплексном лечении ГБ II стадии. На фоне терапии фиксируются стойкое достижение целевых цифр, повышение вагального тонуса. Отмечается метаболическая нейтральность препарата, а также нефро- и кардиопротективные действия.
Ключевые слова: артериальная гипертензия, рамиприл, индапамид
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Relevance. Arterial hypertension is one of the most common cardiovascular diseases in the adult population, but much has already been achieved in its treatment. The advantages of combination therapy, according to the clinical recommendations "Arterial Hypertension in Adults" in 2020, are as follows: an increase in the degree of blood pressure reduction is much stronger than an increase in the dose of a single drug; the possibility of physiological and pharmacological synergy between drugs of different classes, which may underlie a more pronounced reduction in blood pressure and better tolerability of treatment; suppression of the opposite mechanisms of increasing blood pressure.
Aim. Aim of the study was to study the effect of the antihypertensive drug – Konsilar-D24 on the clinical picture, HRV data, and hemodynamic parameters in patients with stage II hypertension of the 2nd degree.
Materials and methods. 40 patients with stage II AH and grade 2 AH were examined. During the outpatient examination, all patients were evaluated for HRV, SCAD, SMAD, ECHO-KG, ECG, GFR, laboratory and biochemical examination (UAC, OAM, blood bch-creatinine, urea, glucose, ASAT, ALAT), and the SF-36 quality of life questionnaire.
Results. An increase in SVVR, a decrease in blood pressure, and an increase in the quality of life of the patient. Discussion: Konsilar-D24 is an effective antihypertensive agent for grade 2 hypertension in the complex treatment of stage II hypertension. Against the background of therapy, there is a persistent achievement of target figures, an increase in vagal tone. There is a metabolic neutrality of the drug, as well as nephro and cardioprotective effects.
Keywords: arterial hypertension, ramipril, indapamide
Полный текст
Список литературы
1. Franklin SS, Lopez VA, Wong ND, et al. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation 2009; 119 (2): 243–50. DOI: 10.1161/CIRCULATIONAHA. 108. 797936
2. Williams B, Mancia G, Spiering W, et al. 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 and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension [published correction appears in J Hypertens. 2019; 37 (1): 226]. J Hypertens. 2018; 36 (10): 1953–2041. DOI: 10.1097/HJH.0000000000001940
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8. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering on outcome incidence in hypertension: 5. Head-to-head comparisons of various classes of antihypertensive drugs – overview and meta-analyses. J Hypertens 2015; 33: 1321–41. DOI: 10.1097/HJH.0000000000000614
9. Volpe M, Mancia G, Trimarco B. Angiotensin II receptor blockers and myocardial infarction: deeds and misdeeds. J Hypertens 2005; 23: 2113–18. DOI:
10.1097/01.hjh.0000194114.12228.16
10. Reboldi G, Angeli F, Cavallini C, et al. Comparison between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the risk of myocardial infarction, stroke and death: a meta-analysis. J Hypertens 2008; 26: 1282–9. DOI: 10.1097/HJH.0b013e328306ebe2
11. Unger T, Ganten D, Lang RE. Tissue converting enzyme and cardiovascular actions of converting enzyme inhibitors. J Cardiovasc Pharmacol 1986; 8 (Suppl. 10): S75–81. DOI: 10.1097/00005344-198600101-00015
12. Zhuo JL, Mendelsohn FA, Ohishi M. Perindopril alters vascular angiotensin-converting enzyme, AT (1) receptor, and nitric oxide synthase expression in patients with coronary heart disease. Hypertension 2002; 39 (2 Pt 2): 634–8. DOI: 10.1161/hy0202.103417
13. Ferrari R. Preserving bradykinin or blocking angiotensin II: the cardiovascular dilemma. Dialogues Cardiovasc Med 2004; 9 (2): 71–89.
14. Morgan T, Anderson A. Clinical efficacy of perindopril in hypertension. Clin Exp Pharmacol Physiol Suppl. 1992; 19: 61–5. DOI: 10.1111/j.1440-1681.1992.tb02812.x
15. Famsworth A. Angiotensin-converting enzyme inhibitors in heart failure: target dose prescription in elderly patients. Age Ageing 1998: 27 (5): 653–4. DOI: 10.1093/ageing/27.5.653
16. Ceconi C, Francolini G, Olivares A, et al. Angiotensin-converting enzyme (ACE) inhibitors have different selectivity for bradykinin binding sites of human somatic ACE. Eur J Pharmacol 2007; 577 (1–3): 1–6. DOI: 10.1016/j.ejphar.2007.07.061
17. Frampton JE, Peters DH. Ramipril: an updated review of its therapeutic use in essential hypertension and heart failure. Drugs 1995; 49: 440–66. DOI: 10.2165/00003495-199549030-00008
18. Van Griensven JM, Schoemaker RC, Cohen AF, et al. Pharmacokinetics, pharmacodynamics and bioavailability of the ACE inhibitor ramipril. Eur J Clin Pharmacol 1995; 47: 513–8. DOI: 10.1007/bf00193704
19. Altace Pharmacology. Available at: www.rxlist.com/cgi/generic/ramipril_cp.htm
20. Witte PU, Walter U. Comparative double-blind study of ramipril and captopril in mild to moderate hypertension. Am J Cardiol 1987; 59: 115D–20D. DOI: 10.1016/0002-9149 (87)90065-8
21. Ruddy MC, Mroczek WJ. Comparison of ramipril and enalapril in patients with essential hypertension. Pharmacotherapy 1993; 13: 224–8.
22. Lonn E, Shaikholeslami R, Yi Q, et al. Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular ejection fraction: a substudy of the Heart Outcomes Prevention Evaluation (HOPE) Trial. J Am Coll Cardiol 2004; 43: 2200–6. DOI: 10.1016/j.jacc.2003.10.073
23. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs – overview and meta-analyses. J Hypertens 2015; 33: 195–211. DOI: 10.1097/HJH.0000000000000447
24. Leonetti G, Rappelli A, Salvetti A, et al. Long-term effects of indapamide: final results of a 2-year Italian multicenter study in systemic hypertension. Am J Cardiol 1990; 65: 67–71. DOI: 10.1016/0002-9149 (90)90347-4
25. Chaffman M, Heel RC, Brodgen RN, et al. Indapamide: a review of its pharmacodynamic properties and therapeutic efficacy in hypertension. Drugs 1984; 28 (3): 189–235. DOI: 10.2165/00003495-198428030-00001
26. Senior R, Imbs JL, Bory M, et al. Indapamide reduces hypertensive left ventricular hypertrophy: an international multicenter study. J Cardiovasc Pharmacol 1993; 22 (Suppl. 6): S106–S10.
27. Carey PA, Sheridan DJ, de Cordoue A, Guez D. Effect of indapamide on left ventricular hypertrophy in hypertension: a meta-analysis. Am J Cardiol 1996; 77 (6): 17b–9b. DOI: 10.1016/s0002-9149 (97)89234-x
28. Ames RP. A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides. Am J Cardiol 1996; 77 (6): 12b–6b. DOI: 10.1016/s0002-9149 (97)89233-8
29. Конради А.О., Недогода С.В., Недошивин А.О. и др. Современная антигипертензивная терапия: возможности уникальной российской фиксированной комбинации рамиприла и индапамида. Рос. кардиологический журн. 2020; 25 (3): 89–97 [Konradi A.O., Nedogoda S.V., Nedoshivin A.O., et al. A.Modern antihypertensive therapy: the possibilities of a unique Russian fixed combination of ramipril and indapamide. Russian Journal of Cardiology. 2020; 25 (3): 89–97 (in Russian).]
30. Минаков Э.В., Кочеткова И.В., Стрелецкая Г.Н. Прогнозирование суммарного эффекта вегетативной регуляции кровообращения в процессе лечения. Врач-аспирант. 2014; 63 (2.1): 191–6 [Minakov E.V., Kochetkova I.V., Streletskaya G.N. Prediction of the total effect of vegetative regulation of blood circulation in the course of treatment. Doctor-postgraduate student. 2014; 63 (2.1): 191–6 (in Russian).]
31. Садкова Е.В., Стрелецкая Г.Н., Кочеткова И.В. Исследование вариабельности сердечного ритма в оценке функционального состояния сердечно-сосудистой системы у больных сахарным диабетом 1-го и 2-го типа. Молодежный инновационный вестн. 2015; 4 (1): 74–5 [Sadkova E.V., Streletskaya G.N., Kochetkova I.V. Study of heart rate variability in the assessment of the functional state of the cardiovascular system in patients with diabetes mellitus 1 and 2. Molodezhny innovatsionny vestnik. 2015; 4 (1): 74–5 (in Russian).]
2. Williams B, Mancia G, Spiering W, et al. 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 and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension [published correction appears in J Hypertens. 2019; 37 (1): 226]. J Hypertens. 2018; 36 (10): 1953–2041. DOI: 10.1097/HJH.0000000000001940
3. Муромцева Г.А., Концевая А.В., Константинов В.В. и др. Распространенность факторов риска неинфекционных заболеваний в российской популяции в 2012–2013 гг. Результаты исследования ЭССЕ-РФ. Кардиоваскулярная терапия и профилактика. 2014; 13 (6): 4–11 [Muromtseva G.A., Kontsevaya A.V., Konstantinov V.V., et al. The prevalence of non-infectious diseases risk factors in russian population in 2012–2013 years. The results of ECVD-RF. Cardiovascular Therapy and Prevention. 2014; 13 (6): 4–11 (in Russian).]. DOI: 10.15829/1728-8800-2014-6-4-11
4. Бойцов С.А., Баланова Ю.А., Шальнова С.А. и др. Артериальная гипертония среди лиц 25–64 лет: распространенность, осведомленность, лечение и контроль. По материалам исследования ЭССЕ. Кардиоваскулярная терапия и профилактика. 2014; 4: 4–14 [Boytsov S.A., Balanova Y.A., Shalnova S.A., et al. Arterial hypertension among individuals of 25-64 years old: prevalence, awareness, treatment and control. by the data from ECCD. Cardiovascular Therapy and Prevention. 2014; 13 (4): 4–14 (in Russian).]. DOI: 10.15829/1728-8800-2014-4-4-14
5. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365: 217–23. DOI: 10.1016/S0140-6736 (05)17741-1
6. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Рос. кардиологический журн. 2020; 25 (3): 3786 [Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020; 25 (3): 3786 (in Russian).]. DOI: 10.15829/1560-4071-2020-3-3786
7. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387: 957–67. DOI: 10.1016/S0140-6736 (15)01225-8
8. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering on outcome incidence in hypertension: 5. Head-to-head comparisons of various classes of antihypertensive drugs – overview and meta-analyses. J Hypertens 2015; 33: 1321–41. DOI: 10.1097/HJH.0000000000000614
9. Volpe M, Mancia G, Trimarco B. Angiotensin II receptor blockers and myocardial infarction: deeds and misdeeds. J Hypertens 2005; 23: 2113–18. DOI:
10.1097/01.hjh.0000194114.12228.16
10. Reboldi G, Angeli F, Cavallini C, et al. Comparison between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on the risk of myocardial infarction, stroke and death: a meta-analysis. J Hypertens 2008; 26: 1282–9. DOI: 10.1097/HJH.0b013e328306ebe2
11. Unger T, Ganten D, Lang RE. Tissue converting enzyme and cardiovascular actions of converting enzyme inhibitors. J Cardiovasc Pharmacol 1986; 8 (Suppl. 10): S75–81. DOI: 10.1097/00005344-198600101-00015
12. Zhuo JL, Mendelsohn FA, Ohishi M. Perindopril alters vascular angiotensin-converting enzyme, AT (1) receptor, and nitric oxide synthase expression in patients with coronary heart disease. Hypertension 2002; 39 (2 Pt 2): 634–8. DOI: 10.1161/hy0202.103417
13. Ferrari R. Preserving bradykinin or blocking angiotensin II: the cardiovascular dilemma. Dialogues Cardiovasc Med 2004; 9 (2): 71–89.
14. Morgan T, Anderson A. Clinical efficacy of perindopril in hypertension. Clin Exp Pharmacol Physiol Suppl. 1992; 19: 61–5. DOI: 10.1111/j.1440-1681.1992.tb02812.x
15. Famsworth A. Angiotensin-converting enzyme inhibitors in heart failure: target dose prescription in elderly patients. Age Ageing 1998: 27 (5): 653–4. DOI: 10.1093/ageing/27.5.653
16. Ceconi C, Francolini G, Olivares A, et al. Angiotensin-converting enzyme (ACE) inhibitors have different selectivity for bradykinin binding sites of human somatic ACE. Eur J Pharmacol 2007; 577 (1–3): 1–6. DOI: 10.1016/j.ejphar.2007.07.061
17. Frampton JE, Peters DH. Ramipril: an updated review of its therapeutic use in essential hypertension and heart failure. Drugs 1995; 49: 440–66. DOI: 10.2165/00003495-199549030-00008
18. Van Griensven JM, Schoemaker RC, Cohen AF, et al. Pharmacokinetics, pharmacodynamics and bioavailability of the ACE inhibitor ramipril. Eur J Clin Pharmacol 1995; 47: 513–8. DOI: 10.1007/bf00193704
19. Altace Pharmacology. Available at: www.rxlist.com/cgi/generic/ramipril_cp.htm
20. Witte PU, Walter U. Comparative double-blind study of ramipril and captopril in mild to moderate hypertension. Am J Cardiol 1987; 59: 115D–20D. DOI: 10.1016/0002-9149 (87)90065-8
21. Ruddy MC, Mroczek WJ. Comparison of ramipril and enalapril in patients with essential hypertension. Pharmacotherapy 1993; 13: 224–8.
22. Lonn E, Shaikholeslami R, Yi Q, et al. Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular ejection fraction: a substudy of the Heart Outcomes Prevention Evaluation (HOPE) Trial. J Am Coll Cardiol 2004; 43: 2200–6. DOI: 10.1016/j.jacc.2003.10.073
23. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs – overview and meta-analyses. J Hypertens 2015; 33: 195–211. DOI: 10.1097/HJH.0000000000000447
24. Leonetti G, Rappelli A, Salvetti A, et al. Long-term effects of indapamide: final results of a 2-year Italian multicenter study in systemic hypertension. Am J Cardiol 1990; 65: 67–71. DOI: 10.1016/0002-9149 (90)90347-4
25. Chaffman M, Heel RC, Brodgen RN, et al. Indapamide: a review of its pharmacodynamic properties and therapeutic efficacy in hypertension. Drugs 1984; 28 (3): 189–235. DOI: 10.2165/00003495-198428030-00001
26. Senior R, Imbs JL, Bory M, et al. Indapamide reduces hypertensive left ventricular hypertrophy: an international multicenter study. J Cardiovasc Pharmacol 1993; 22 (Suppl. 6): S106–S10.
27. Carey PA, Sheridan DJ, de Cordoue A, Guez D. Effect of indapamide on left ventricular hypertrophy in hypertension: a meta-analysis. Am J Cardiol 1996; 77 (6): 17b–9b. DOI: 10.1016/s0002-9149 (97)89234-x
28. Ames RP. A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides. Am J Cardiol 1996; 77 (6): 12b–6b. DOI: 10.1016/s0002-9149 (97)89233-8
29. Конради А.О., Недогода С.В., Недошивин А.О. и др. Современная антигипертензивная терапия: возможности уникальной российской фиксированной комбинации рамиприла и индапамида. Рос. кардиологический журн. 2020; 25 (3): 89–97 [Konradi A.O., Nedogoda S.V., Nedoshivin A.O., et al. A.Modern antihypertensive therapy: the possibilities of a unique Russian fixed combination of ramipril and indapamide. Russian Journal of Cardiology. 2020; 25 (3): 89–97 (in Russian).]
30. Минаков Э.В., Кочеткова И.В., Стрелецкая Г.Н. Прогнозирование суммарного эффекта вегетативной регуляции кровообращения в процессе лечения. Врач-аспирант. 2014; 63 (2.1): 191–6 [Minakov E.V., Kochetkova I.V., Streletskaya G.N. Prediction of the total effect of vegetative regulation of blood circulation in the course of treatment. Doctor-postgraduate student. 2014; 63 (2.1): 191–6 (in Russian).]
31. Садкова Е.В., Стрелецкая Г.Н., Кочеткова И.В. Исследование вариабельности сердечного ритма в оценке функционального состояния сердечно-сосудистой системы у больных сахарным диабетом 1-го и 2-го типа. Молодежный инновационный вестн. 2015; 4 (1): 74–5 [Sadkova E.V., Streletskaya G.N., Kochetkova I.V. Study of heart rate variability in the assessment of the functional state of the cardiovascular system in patients with diabetes mellitus 1 and 2. Molodezhny innovatsionny vestnik. 2015; 4 (1): 74–5 (in Russian).]
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1. Franklin SS, Lopez VA, Wong ND, et al. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation 2009; 119 (2): 243–50. DOI: 10.1161/CIRCULATIONAHA. 108. 797936
2. Williams B, Mancia G, Spiering W, et al. 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 and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension [published correction appears in J Hypertens. 2019; 37 (1): 226]. J Hypertens. 2018; 36 (10): 1953–2041. DOI: 10.1097/HJH.0000000000001940
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Авторы
И.В. Кочеткова*
ФГБОУ ВО «Воронежский государственный медицинский университет им. Н.Н. Бурденко» Минздрава России, Воронеж, Россия
*iri4217@yandex.ru
ФГБОУ ВО «Воронежский государственный медицинский университет им. Н.Н. Бурденко» Минздрава России, Воронеж, Россия
*iri4217@yandex.ru
________________________________________________
Irina V. Kochetkovа*
Burdenko Voronezh State Medical University, Voronezh, Russia
*iri4217@yandex.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.