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Влияние комбинированной блокады ренин-ангиотензин-альдостероновой системы с применением Расилеза и эналаприла на уровень микроальбуминурии у больных гипертонической болезнью
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Аннотация
Ренин-ангиотензин-альдостероновая система (РААС) является ключевым звеном в регуляции артериального давления и обусловливает поражение органов-мишеней у больных гипертонической болезнью. В течение многих лет не пропадает интерес к фармакологической блокаде РААС с целью профилактики поражения органов-мишеней, в частности почек. Относительно недавно для клинического применения рекомендован прямой ингибитор ренина – алискирен, доказавший выраженный нефропротективный эффект. Однако в настоящее время нет однозначного ответа на вопрос, имеются ли преимущества в комбинированной блокаде РААС у больных гипертонической болезнью с использованием алискирена и ингибиторов ангиотензинпревращающего фермента.
Ключевые слова: нефропротекция, прямой ингибитор ренина, алискирен, микроальбуминурия, артериальная гипертензия, ингибиторы ангиотензинпревращающего фермента.
Ключевые слова: нефропротекция, прямой ингибитор ренина, алискирен, микроальбуминурия, артериальная гипертензия, ингибиторы ангиотензинпревращающего фермента.
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Renin-angiotensin-aldosterone system is a key link in regulation of blood pressure which causes target organ damage in hypertensive patients. The interest in the pharmacological RAAS blockade for target organ damage (particularly - kidneys) prevention has existed for many years. Recently the direct renin inhibitor aliskiren was recommended for clinical application. A number of multicenter randomized studies have proven pronounced nephroprotective effect. However, at present there is no unequivocal answer to the question whether there are advantages in combined RAAS blockade in hypertensive patients using aliskiren and angiotensin-converting enzyme inhibitor.
Key words: nephroprotection, direct renin inhibitor, aliskiren, microalbuminuria, arterial hypertension, angiotensinconverting enzyme inhibitor.
Полный текст
Список литературы
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5. Mathiesen ER, Hommel E, Hansen HP et al. Randomised controlled trial of long term efficacy of captopril on preservation of kidney function in normotensive patients with insulin dependent diabetes and microalbuminuria. BMJ 1999; 319: 24–5.
6. Viberti G, Mogensen CE, Groop LC, Pauls JF. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. European Microalbuminuria Captopril Study Group. JAMA 1994; 271: 275–9.
7. Agardh CD, Garcia-Puig J, Charbonnei В et al. Greater reduction of urinary albumin excretion in hypertensive type II diabetic patients with incipient nephropathy by lisinopril than by nifedipine. J Hum Hypertens 1996; 10: 185–92.
8. The EUCLID study group. Randomised placebo-controlled trial of lisinopril in non-nypenensive patients with insulin dependent diabetes and normoalbuminuria or microalbuminuna. Lancet 1997; 349: 1787–92.
9. Brenner BM, Cooper ME, de Zeeuw D et al. The Losartan Renal Protection Study: rationale, study design and baseline characteristics of RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan). J Renin Angiotensin Aldosterone Syst 2000; 1 (4): 328–35.
10. Bramlage P, Pittrow D, Kirch W. The effect of irbesartan in reducing cardiovascular risk in hypertensive type 2 diabetic patients: an observational study in 16,600 patients in primary care. Curr Med Res Opin 2004; 20 (10): 1625–31.
11. Schmieder RE, Krekler M. Observational study of blood pressure control and microalbuminuria in type 2 diabetics on irbesartan or irbesartan/ HCTZ. MMW Fortschr Med 2005; 147 (Suppl. 3): 97–101.
12. Diercks GF, Janssen WM, van Boven AJ et al. Rationale, design, and baseline characteristics of a trial of prevention of cardiovascular and renal disease with fosinopril and pravastatin in nonhypertensive, nonhypercholesterolemic subjects with microalbuminuria (the Prevention of REnal and Vascular ENdstage Disease Intervention Trial (PREVEND IT). Am J Cardiol 2000; 86: 635–8.
13. The HOPE Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253–9.
14. Uresin Y, Taylor A, Kilo C et al. Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. J Renin Angiotensin Aldosterone Syst 2007; 8: 190–8.
15. Parving HH, Persson F, Lewis JB et al. AVOID Study Investigators. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 2008; 358: 2433–46.
16. Muller DN, Luft FC. Direct renin inhibition with aliskiren in hypertension and target organ damage. Clin J Am Soc Nephrol 2006; 1: 221–8.
17. Lekatsas I, Koulouris S, Triantafyllou K et al. Prognostic significance of microalbuminuria in non-diabetic patients with acute myocardial infarction. Int J Cardiol 2006; 106 (2): 218–23.
18. Szczudlik A, Turaj W, Slowik A, Strojny J. Microalbuminuria and hyperthermia independently predict long-term mortality in acute ischemic stroke patients. Acta Neurol Scand 2003; 107: 96–101.
19. Terao Y, Miura K, Ichinomiya T et al. Admission microalbuminuria and neurologic outcomes in intensive care unit patients with spontaneous intracerebral hemorrhage. J Neurosurg Anesthesiol 2008; 20 (3): 163–8.
20. Torun D, Sezer S, Arat Z et al. The frequency of combined target organ damage and the beneficial effect of ambulatory blood pressure monitoring in never treated mild-to-moderate hypertensive patients. Int Heart J 2005; 46 (6): 1073–82.
21. Munakata M, Nunokawa T, Yoshinaga K et al. Brachial-ankle pulse wave velocity is an independent risk factor for microalbuminuria in patients with essential hypertension – a Japanese trial on the prognostic implication of pulse wave velocity (J-TOPP). Hypertens Res 2006; 29 (7): 515–21.
22. Furtner M, Kiechl S, Mair A et al. Urinary albumin excretion is independently associated with carotid and femoral artery atherosclerosis in the general population. Eur Heart J 2005; 26: 279–87.
23. Ruilope LM, Alcazar JM, Hernandez E et al. Long-term influence of antihypertensive therapy on microalbuminuria in essential hypertension Kydney Int 1994; 45: 171–3.
24. Giatras I, Lau J, Levey AS. Effect of angiotensin–converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta–analysis of randomized trials. Ann Intern Med 1997; 127: 337–45.
25. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia. Randomized placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric non-diabetic nephropathy. Lancet 1997; 349: 1857–63.
26. Azizi M, Webb R, Nussberger J, Hollenberg NK. Renin inhibition with aliskiren: where are we now, and wh ere are we going? J Hypertens 2006; 24: 243–56.
2. Sarnak MJ, Levey AS, Schoolwerth AC et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement fr om the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003; 42: 1050–65.
3. Garg JP, Bakris GL. Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease. Vase Med 2002; 7: 35–43.
4. Naidoo DP. The link between microalbuminuria, endothelial dysfunction and cardiovascular disease in diabetes. Cardiovasc J S Afr 2002; 13: 194–9.
5. Mathiesen ER, Hommel E, Hansen HP et al. Randomised controlled trial of long term efficacy of captopril on preservation of kidney function in normotensive patients with insulin dependent diabetes and microalbuminuria. BMJ 1999; 319: 24–5.
6. Viberti G, Mogensen CE, Groop LC, Pauls JF. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. European Microalbuminuria Captopril Study Group. JAMA 1994; 271: 275–9.
7. Agardh CD, Garcia-Puig J, Charbonnei В et al. Greater reduction of urinary albumin excretion in hypertensive type II diabetic patients with incipient nephropathy by lisinopril than by nifedipine. J Hum Hypertens 1996; 10: 185–92.
8. The EUCLID study group. Randomised placebo-controlled trial of lisinopril in non-nypenensive patients with insulin dependent diabetes and normoalbuminuria or microalbuminuna. Lancet 1997; 349: 1787–92.
9. Brenner BM, Cooper ME, de Zeeuw D et al. The Losartan Renal Protection Study: rationale, study design and baseline characteristics of RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan). J Renin Angiotensin Aldosterone Syst 2000; 1 (4): 328–35.
10. Bramlage P, Pittrow D, Kirch W. The effect of irbesartan in reducing cardiovascular risk in hypertensive type 2 diabetic patients: an observational study in 16,600 patients in primary care. Curr Med Res Opin 2004; 20 (10): 1625–31.
11. Schmieder RE, Krekler M. Observational study of blood pressure control and microalbuminuria in type 2 diabetics on irbesartan or irbesartan/ HCTZ. MMW Fortschr Med 2005; 147 (Suppl. 3): 97–101.
12. Diercks GF, Janssen WM, van Boven AJ et al. Rationale, design, and baseline characteristics of a trial of prevention of cardiovascular and renal disease with fosinopril and pravastatin in nonhypertensive, nonhypercholesterolemic subjects with microalbuminuria (the Prevention of REnal and Vascular ENdstage Disease Intervention Trial (PREVEND IT). Am J Cardiol 2000; 86: 635–8.
13. The HOPE Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253–9.
14. Uresin Y, Taylor A, Kilo C et al. Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. J Renin Angiotensin Aldosterone Syst 2007; 8: 190–8.
15. Parving HH, Persson F, Lewis JB et al. AVOID Study Investigators. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 2008; 358: 2433–46.
16. Muller DN, Luft FC. Direct renin inhibition with aliskiren in hypertension and target organ damage. Clin J Am Soc Nephrol 2006; 1: 221–8.
17. Lekatsas I, Koulouris S, Triantafyllou K et al. Prognostic significance of microalbuminuria in non-diabetic patients with acute myocardial infarction. Int J Cardiol 2006; 106 (2): 218–23.
18. Szczudlik A, Turaj W, Slowik A, Strojny J. Microalbuminuria and hyperthermia independently predict long-term mortality in acute ischemic stroke patients. Acta Neurol Scand 2003; 107: 96–101.
19. Terao Y, Miura K, Ichinomiya T et al. Admission microalbuminuria and neurologic outcomes in intensive care unit patients with spontaneous intracerebral hemorrhage. J Neurosurg Anesthesiol 2008; 20 (3): 163–8.
20. Torun D, Sezer S, Arat Z et al. The frequency of combined target organ damage and the beneficial effect of ambulatory blood pressure monitoring in never treated mild-to-moderate hypertensive patients. Int Heart J 2005; 46 (6): 1073–82.
21. Munakata M, Nunokawa T, Yoshinaga K et al. Brachial-ankle pulse wave velocity is an independent risk factor for microalbuminuria in patients with essential hypertension – a Japanese trial on the prognostic implication of pulse wave velocity (J-TOPP). Hypertens Res 2006; 29 (7): 515–21.
22. Furtner M, Kiechl S, Mair A et al. Urinary albumin excretion is independently associated with carotid and femoral artery atherosclerosis in the general population. Eur Heart J 2005; 26: 279–87.
23. Ruilope LM, Alcazar JM, Hernandez E et al. Long-term influence of antihypertensive therapy on microalbuminuria in essential hypertension Kydney Int 1994; 45: 171–3.
24. Giatras I, Lau J, Levey AS. Effect of angiotensin–converting enzyme inhibitors on the progression of nondiabetic renal disease: a meta–analysis of randomized trials. Ann Intern Med 1997; 127: 337–45.
25. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia. Randomized placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric non-diabetic nephropathy. Lancet 1997; 349: 1857–63.
26. Azizi M, Webb R, Nussberger J, Hollenberg NK. Renin inhibition with aliskiren: where are we now, and wh ere are we going? J Hypertens 2006; 24: 243–56.
Авторы
В.А.Качнов, А.В.Кольцов, В.В.Тыренко, А.Э.Никитин, Д.О.Синопальников, О.В.Щербатюк, М.Е.Мешкова, В.Д.Ветушко
Военно-медицинская академия им. С.М.Кирова, Санкт-Петербург
Военно-медицинская академия им. С.М.Кирова, Санкт-Петербург
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V..А.Kachnov, A.V.Koltsov, V.V.Tyrenko, A.E.Nikitin, D.O.Sinopalnikov, O.V.Sherbatuk, M.E.Meshkova, V.D.Vetushko
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