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b-Блокаторы – доказано!
b-Блокаторы – доказано!
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Аннотация
В статье приведен обзор одной из самых интересных кардиологических групп лекарственных препаратов – b-адреноблокаторов. Рассмотрены основные их свойства, сферы клинического применения – у пациентов после перенесенного инфаркта миокарда, при стабильных формах ишемической болезни сердца, артериальной гипертензии, в качестве профилактики аритмий и для контроля Частоты сердечных сокращений у пациентов при фибрилляции предсердий, при сахарном диабете. В качестве аргументов использованы данные рандомизированных клинических исследований и метаанализов. Показано, что клинические данные по отдельным b-блокаторам не являются группа-специфичными. Преимуществами при лечении АГ обладают липофильные препараты, гидрофильный же атенолол не рекомендован в качестве гипотензивного средства.
Ключевые слова: b-адреноблокаторы, бисопролол, сердечно-сосудистые события, артериальная гипертензия.
Key words: beta-adrenoblockers, bisoprolol, cardiovascular events, arterial hypertension.
Ключевые слова: b-адреноблокаторы, бисопролол, сердечно-сосудистые события, артериальная гипертензия.
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Key words: beta-adrenoblockers, bisoprolol, cardiovascular events, arterial hypertension.
Полный текст
Список литературы
1. Kannel W, Kannel C, Paffenbarger RS Jr, Cupples LA. Heart rate and cardiovascular mortality: the Framingham Study. Am Heart J 1987; 113: 1489–94.
2. Kjekshus J, Gullestad L. Heart rate as a therapeutic target in heart failure. Eur Heart J 1999; 1: H64–9.
3. Messerli FH, Grossman E, Goldbourt U. Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review JAMA 1998; 279: 1903–7.
4. Aronow WS, Ahn C. Incidence of new coronary events in older persons with prior myocardial infarction and systemic hypertension treated with beta-blockers, angiotensin-converting enzyme inhibitors, diuretics, calcium antagonists, and alpha blockers. Am J Cardiol 2002; 89: 1207–9.
5. Kjekshus JK. Importance of heart rate in determining beta-blocker efficacy in acute and long-term acute myocardial infarction intervention trials. Am J Cardiol 1986; 57: 43F–9F.
6. Cucherat M. Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction: a meta-regression of randomized clinical trials. Eur Heart J 2007; 28: 3012–19.
7. Smith SC Jr, Allen J, Blair SN et al. ACC/AHA guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung and Blood Institute. Circulation 2006; 113: 2363–72.
8. Smith SC Jr, Blair SN, Bonow RO et al. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2001; 38: 1581–3.
9. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289: 2560–72.
10. Mancia G, Laurent S, Agabiti-Rosei E et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27: 2121–58.
11. Goch A, Banach M, Mikhailidis DP et al. Endothelial dysfunction in patients with noncomplicated and complicated hypertension. Clin Exp Hypertens 2009; 31: 20–30.
12. Navneet S Mechanisms of the beneficial effects of beta-adrenoceptor antagonists in congestive heart failure. Exp Clin Cardiol 2010; 15 (4): e86–95.
13. Marazzi G, Iellamo F, Volterrani M, Caminiti G et al. Comparison of effectiveness of carvedilol versus bisoprolol for prevention of postdischarge atrial fibrillation after coronary artery bypass grafting in patients with heart failure. Am J Cardiol 2011; 107 (2): 215–9. Epub 2010 Dec 2.
14. Wang B, Song WH, Liu GZ. Multi-center Cooperation Group of Bisoprolol. The effect long-term administration of a selective beta1 blocker bisoprolol on glucose metabolism in patients with essential hypertensive and type 2 diabetes mellitus. Zhonghua Nei Ke Za Zhi 2005; 44 (7): 503–5.
15. Haas SJ, Vos T, Gilbert RE, Krum H. Are beta-blockers as efficacious in patients with diabetes mellitus as in patients without diabetes mellitus who have chronic heart failure? A meta-analysis of large-scale clinical trials. Am Heart J 2003; 146 (5): 848–53.
16. Kokkinos P, Chrysohoou C, Panagiotakos D et al. Beta-blockade mitigates exercise blood pressure in hypertensive male patients. J Am Coll Cardiol 2006; 47: 794.
17. Lopez-Sendon J, Swedberg K, McMurray J et al. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J 2004; 25: 1341–62.
18. Manrique C, Giles TD, Ferdinand KC et al. Realities of newer beta-blockers for the management of hypertension. J Clin Hypertens 2009; 11: 369–75.
19. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38, 39. Brit Med J 1998; 317: 703–9.
2. Kjekshus J, Gullestad L. Heart rate as a therapeutic target in heart failure. Eur Heart J 1999; 1: H64–9.
3. Messerli FH, Grossman E, Goldbourt U. Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review JAMA 1998; 279: 1903–7.
4. Aronow WS, Ahn C. Incidence of new coronary events in older persons with prior myocardial infarction and systemic hypertension treated with beta-blockers, angiotensin-converting enzyme inhibitors, diuretics, calcium antagonists, and alpha blockers. Am J Cardiol 2002; 89: 1207–9.
5. Kjekshus JK. Importance of heart rate in determining beta-blocker efficacy in acute and long-term acute myocardial infarction intervention trials. Am J Cardiol 1986; 57: 43F–9F.
6. Cucherat M. Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction: a meta-regression of randomized clinical trials. Eur Heart J 2007; 28: 3012–19.
7. Smith SC Jr, Allen J, Blair SN et al. ACC/AHA guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung and Blood Institute. Circulation 2006; 113: 2363–72.
8. Smith SC Jr, Blair SN, Bonow RO et al. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2001; 38: 1581–3.
9. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289: 2560–72.
10. Mancia G, Laurent S, Agabiti-Rosei E et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27: 2121–58.
11. Goch A, Banach M, Mikhailidis DP et al. Endothelial dysfunction in patients with noncomplicated and complicated hypertension. Clin Exp Hypertens 2009; 31: 20–30.
12. Navneet S Mechanisms of the beneficial effects of beta-adrenoceptor antagonists in congestive heart failure. Exp Clin Cardiol 2010; 15 (4): e86–95.
13. Marazzi G, Iellamo F, Volterrani M, Caminiti G et al. Comparison of effectiveness of carvedilol versus bisoprolol for prevention of postdischarge atrial fibrillation after coronary artery bypass grafting in patients with heart failure. Am J Cardiol 2011; 107 (2): 215–9. Epub 2010 Dec 2.
14. Wang B, Song WH, Liu GZ. Multi-center Cooperation Group of Bisoprolol. The effect long-term administration of a selective beta1 blocker bisoprolol on glucose metabolism in patients with essential hypertensive and type 2 diabetes mellitus. Zhonghua Nei Ke Za Zhi 2005; 44 (7): 503–5.
15. Haas SJ, Vos T, Gilbert RE, Krum H. Are beta-blockers as efficacious in patients with diabetes mellitus as in patients without diabetes mellitus who have chronic heart failure? A meta-analysis of large-scale clinical trials. Am Heart J 2003; 146 (5): 848–53.
16. Kokkinos P, Chrysohoou C, Panagiotakos D et al. Beta-blockade mitigates exercise blood pressure in hypertensive male patients. J Am Coll Cardiol 2006; 47: 794.
17. Lopez-Sendon J, Swedberg K, McMurray J et al. Expert consensus document on beta-adrenergic receptor blockers. Eur Heart J 2004; 25: 1341–62.
18. Manrique C, Giles TD, Ferdinand KC et al. Realities of newer beta-blockers for the management of hypertension. J Clin Hypertens 2009; 11: 369–75.
19. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38, 39. Brit Med J 1998; 317: 703–9.
Авторы
Е.Г.Силина, Л.А.Алексанян
ГОУ ВПО Московский государственный медико-стоматологический университет Минздравсоцразвития РФ
Moscow State University of Medicine and Dentistry
ГОУ ВПО Московский государственный медико-стоматологический университет Минздравсоцразвития РФ
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Moscow State University of Medicine and Dentistry
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