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b-Адреноблокаторы вчера, сегодня и завтра: смогут ли они остаться в группе основных лекарственных средств?
b-Адреноблокаторы вчера, сегодня и завтра: смогут ли они остаться в группе основных лекарственных средств?
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
b-Адреноблокаторы (БАБ) в реальной клинической практике применяются с 1960-х годов. В течение первых 20 лет применения короткодействующих и в основном неселективных БАБ об этой группе в реальной клинической практике сформировано достаточное количество отрицательных отзывов за счет побочных эффектов. В 1980-х годах была синтезирована новая генерация БАБ (пролонгированных и кардиоселективных), которые сохранили, как и предыдущая генерация, активное влияние на ритм и артериальное давление, но изменили профиль безопасности и значительно повысили уровень эффективности в отношении профилактики сердечно-сосудистой смертности и заболеваемости. Врачи реальной клинической практики психологически перенесли все известные побочные эффекты «старых» БАБ на «новые» и создали мифы об отрицательных эффектах современных БАБ. Сложившаяся ситуация значительно снижает активность врачей при подборе оптимальной дозы препарата для больных сердечно-сосудистыми заболеваниями, что искусственно отодвигает их на вторую линию терапии и значительно снижает эффективность самих БАБ.
Ключевые слова: b-адреноблокаторы, контроль ритма, безопасность, эффективность.
Key words: beta-adrenoblockers, rhythm monitoring, safety, efficacy.
Ключевые слова: b-адреноблокаторы, контроль ритма, безопасность, эффективность.
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Key words: beta-adrenoblockers, rhythm monitoring, safety, efficacy.
Полный текст
Список литературы
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16. Turnbull F. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. BMJ 2008; 336: 1121–3.
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19. Hedblad B, Wikstrand J, Janzon L et al. Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: main results from the Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001; 103: 1721–6.
20. Herlitz J, Elmfeldt D, Holmberg S et al. Goteborg Metoprolol Trial: mortality and causes of death. Am J Cardiol 1984; 53: 9D–14D.
21. Kjekshus J, Gilpin E, Cali G et al. Diabetic patients and β-blockers after acute myocardial infarction. Eur Heart J 1990; 11: 43–50.
22. Malmberg K, Herlitz J, Hjalmarson A, Ryden L. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies. Eur Heart J 1989; 10: 423–8.
23. Waagstein F, Bristow MR, Swedberg K et al. For the Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 1993; 342: 1441–6.
2. Simpson E, Beck C, Richard H, Eisenberg MJ et al. Drug prescriptions after acute myocardial infarction: dosage, compliance, and persistence. Am Heart J 2003; 145: 438–44.
3. Gislason GH, Rasmussen JN, Abildstrшm SZ et al. Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction. Eur Heart J 2006; 27, 1153–8.
4. Ferrari R. Prognostic benefits of heart rate reduction in cardiovascular disease. Eur Heart J 2003; 5 (Suppl. G): G10–G4.
5. Fox K, Ford I, Steg PG et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet 2008; 372: 807–16.
6. Kannel WB. Heart rate and cardiovascular mortality. The Framingham Study. Am Heart J 1987; 113: 1489–94.
7. The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Guidelines on the management of stable angina pectoris. The European Society of Cardiology 2006.
8. Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet 2004; 364: 1684–9.
9. Freemantle N, Urdahl H, Eastaugh J, Hobbs FD. What is the place of beta-blockade in patients who have experienced a myocardial infarction with preserved left ventricular function? Evidence and (mis)interpretation. Prog Cardiovasc Dis 2002; 44: 243–50.
10. Mancia G et al. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28: 1462–536.
11. Diaz A, Bourassa M, Guertin M, Tardiff J. Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J 2005; 26: 967–74.
12. Levine H. Rest heart rate and life expectancy. J Am Coll Cardiol 1997; 30: 1104–6.
13. Bradley HA, Wiysonge CS, Volmink JA et al. How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analysis. J Hypertens 2006; 24 (11): 2131–41.
14. Wiysonge CS, Bradley H, Mayosi BM et al. Beta-blockers for hypertension. Evid Based Med 2007; 12 (4): 112.
15. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies BMJ 2009; 338: b1665 doi: 10.1136/bmj.b1665.
16. Turnbull F. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. BMJ 2008; 336: 1121–3.
17. Chen JM, Heran BS, Perez MI, Wright JM. Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension. Cochrane Database Syst Rev 2010; 20 (1): CD007185.
18. Kendall MJ, Lynch KP, Hjalmarson A et al. β-Blockers and Sudden Cardiac Death. Ann Intern Med 1995; 123: 358–67.
19. Hedblad B, Wikstrand J, Janzon L et al. Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: main results from the Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001; 103: 1721–6.
20. Herlitz J, Elmfeldt D, Holmberg S et al. Goteborg Metoprolol Trial: mortality and causes of death. Am J Cardiol 1984; 53: 9D–14D.
21. Kjekshus J, Gilpin E, Cali G et al. Diabetic patients and β-blockers after acute myocardial infarction. Eur Heart J 1990; 11: 43–50.
22. Malmberg K, Herlitz J, Hjalmarson A, Ryden L. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies. Eur Heart J 1989; 10: 423–8.
23. Waagstein F, Bristow MR, Swedberg K et al. For the Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet 1993; 342: 1441–6.
Авторы
И.В.Фомин*, Д.С.Поляков
Нижегородская государственная медицинская академия
*fomin-i@yandex.ru
Nizhni Novgorod State Medical Academy
*fomin-i@yandex.ru
Нижегородская государственная медицинская академия
*fomin-i@yandex.ru
________________________________________________
Nizhni Novgorod State Medical Academy
*fomin-i@yandex.ru
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