Все ли сартаны одинаковы? Фокус на кандесартан

Все ли сартаны одинаковы? Фокус на кандесартан

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Аннотация

Несмотря на наличие разных свойств у представителей класса блокаторов рецепторов ангиотензина 1-го типа, которые могут влиять на снижение риска сердечно-сосудистых осложнений (ССО), клинические исследования, сравнивающие их эффективность в отношении снижения риска сердечно-сосудистых событий, не проводились. Целью этого исследования была проверка гипотезы о том, что кандесартан и лозартан по-разному влияют на риск ССО у пациентов с артериальной гипертонией (АГ), и при этом эффективность снижения риска не зависит от величины снижения артериального давления. В 72 клинических центрах Швеции отобрали истории болезни пациентов, которым назначались кандесартан или лозартан с 1999 по 2007 г. Из 14 100 пациентов с АГ 6771 принимал лозартан и 7329 кандесартан. Пациенты были занесены в Шведский национальный регистр госпитализаций и летальных исходов. В группах лозартана и кандесартана не зафиксировано различий в снижении артериального давления за время наблюдения. В группе кандесартана по сравнению с лозартаном был ниже риск сердечно-сосудистых событий (р=0,006), сердечной недостаточности (р=0,0004), аритмий (р=0,03) и заболеваний периферических артерий (р=0,01). Отсутствие различий в степени снижения артериального давления позволяет предположить, что разница в снижении риска ССО обусловлена другими механизмами, связанными с различиями в фармакологических свойствах препаратов.

Ключевые слова: эпидемиология, артериальное давление, артериальная гипертония, сердечно-сосудистые заболевания.

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Although angiotensin receptor blockers have different receptor binding properties no comparative studies with cardiovascular disease (CVD) end points have been performed within this class of drugs. The aim of this study was to test the hypothesis that there are blood pressure independent CVD-risk differences between losartan and candesartan treatment in patients with hypertension without known CVD. Seventy-two primary care centres in Sweden were screened for patients who had been prescribed losartan or candesartan between the years 1999 and 2007. Among the 14 100 patients were diagnosed with hypertension and prescribed losartan (n=6771) or candesartan (n=7329). Patients were linked to Swedish national hospitalizations and death cause register. There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up. Compared with the losartan group, the candesartan group had a lower adjusted hazard ratio for total CVD (p=0,006), heart failure (p=0,0004), cardiac arrhythmias (p=0,03), and peripheral artery disease (p=0,1). No difference in blood pressure reduction was observed suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.

Keywords: epidemiology, blood pressure, arterial hypertension, cardiovascular diseases.

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Авторы

И.Е.Чазова, Л.Г.Ратова, Л.Г.Амбатьелло

ФГУ Российский кардиологический научно-производственный комплекс, Москва

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I.E.Chazova, L.G.Ratova, L.G.Ambatiello

FSI Russian cardiology scientific and production complex, Moscow

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