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Эффективность терапии лерканидипином при артериальной гипертензии у пожилых
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Аннотация
В пожилом возрасте распространенность артериальной гипертонии (АГ) достигает 50% и более, и риск развития сердечно-сосудистых осложнений в 3–4 раза выше по сравнению с больными молодого возраста, что определяет важность адекватного контроля АГ у этой категории больных.
Дигидропиридиновые блокаторы кальциевых каналов (БКК) третьего поколения помимо выраженного антигипертензивного действия обладают вазоселективностью, оказывают антиангинальное и органопротективное действие и эффективны при лечении АГ у пожилых.
Представитель дигидропиридиновых БКК лерканидипин отличается высокой липофильностью и вазоселективностью – наибольшей среди БКК третьего поколения. Лерканидипин способен обеспечивать постепенно развивающийся продолжительный антигипертензивный эффект, что позволяет с успехом применять его как в виде монотерапии, так и в составе комбинированной терапии для лечения АГ у пожилых. Лерканидипин метаболически нейтрален, по сравнению с другими БКК имеет лучшую переносимость, при его приеме значительно реже возникают периферические отеки. Хороший профиль переносимости лерканидипина способствует лучшей приверженности долгосрочной антигипертензивной терапии пациентов пожилого возраста.
Ключевые слова: артериальная гипертензия, пожилые, блокатор кальциевых каналов, лерканидипин.
Дигидропиридиновые блокаторы кальциевых каналов (БКК) третьего поколения помимо выраженного антигипертензивного действия обладают вазоселективностью, оказывают антиангинальное и органопротективное действие и эффективны при лечении АГ у пожилых.
Представитель дигидропиридиновых БКК лерканидипин отличается высокой липофильностью и вазоселективностью – наибольшей среди БКК третьего поколения. Лерканидипин способен обеспечивать постепенно развивающийся продолжительный антигипертензивный эффект, что позволяет с успехом применять его как в виде монотерапии, так и в составе комбинированной терапии для лечения АГ у пожилых. Лерканидипин метаболически нейтрален, по сравнению с другими БКК имеет лучшую переносимость, при его приеме значительно реже возникают периферические отеки. Хороший профиль переносимости лерканидипина способствует лучшей приверженности долгосрочной антигипертензивной терапии пациентов пожилого возраста.
Ключевые слова: артериальная гипертензия, пожилые, блокатор кальциевых каналов, лерканидипин.
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In the elderly, the prevalence of essential hypertension (EH) amounts to as much as 50% or more and the cardiovascular risk is 3–4 times higher than that in young patients, which determines the importance of adequate EH control in this category of patients.
In addition to their marked antihypertensive activity, third-generation dihydropyridine calcium channel blockers (CCB) have vasoselective, antianginal, and organ-protective effects and are effective in treating EH in the elderly.
Lercanidipine, a representative of the dihydropyridine CCBs, shows a high lipophilicity and vasoselectivity, which are the highest among the third-generation CCBs. The drug is able to provide a gradually developing long-term antihypertensive effect, which allows its successful use as both monotherapy and part of combination therapy for EH in the elderly. Lercanidipine is metabolically neutral and better tolerable than other CCBs and less frequently causes peripheral edema. Its good tolerability profile contributes to better adherence to long-term antihypertensive therapy in elderly patients.
Key words: essential hypertension, the elderly, calcium channel blocker, lercanidipine.
Полный текст
Список литературы
1. Basile J. Hypertension in the elderly: a review of the importance of systolic blood pressure elevation. J Clin Hypertens (Greenwich) 2002; 4 (2): 108–12, 119.
2. Neaton JD, Killer L, Stamler J et al. Impact of systolic and diastolic blood pressure on cardiovascular mortality. In: Laragh JH, Brenner BM, eds. Hypertension: pathophysiology, diagnosis and management. 2nd ed. New York: Raven Press 1995; 1: 127–44.
3. Pinto E. Blood pressure and ageing. Postgrad Med J 2007; 83 (976): 109–14.
4. Pedelty L, Gorelick PB. Management of hypertension and cerebrovascular disease in the elderly. Am J Med 2008; 121 (Suppl. 8): 23–31.
5. Beckett N, Peters R, Fletcher A et al. The HYVET Study group. Treatment of hypertension in patients 80 years of age or older. N Eng J Med 2008; 358: 1887–98.
6. Lithell H, Hanson L, Skoog I et al. SCOPE study group. The study on cognition and prognosis in elderly (SCOPE). Principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.
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9. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final resultsof the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991; 265 (24): 3255–64.
10. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997; 350 (9080): 757–64.
11. Guarneri L, Angelico P, Ibba M et al. Pharmacological in vitro studies of the new 1,4-dihydropyridine calcium antagonist lercanidipine. Arzneimittelforschung 1996; 46: 15–24.
12. Angelico P, Guarneri L, Leonardi A et al. Vascular-selective effect of lercanidipine and other 1,4-dihydropyridines in isolated rabbit tissues. J Pharm Pharmacol 1999; 51: 709–14.
13. Borghi С. Lercanidipine in hypertensionVascular Health and Risk Management 2005; 1 (3): 173–82.
14. Policicchio D, Magliocca R, Malliani A. Efficacy and tolerability of lercanidipine in patients with mild to moderate essential hypertension: a comparative study with slow-release nifedipine. J Cardiovasc Pharmacol 1997; 29 (Suppl. 2): 31–5.
15. Romito R, Pansini MI, Perticone F et al. Comparative effect of of lercandipine, felodipine and nifedipine GITS on blood pressure and heart rate in patients with mild to moderate arterial hypertension: the Lercandipine in Adults (LEAD) study. J Clin Hypertens 2003; 5 (4): 249–53.
16. Pedrinelli R, Dell’Omo G, Nuti M et al. Heterogenous effect of calcium antagonists on leg oedema: a comparison of amlodipine versus lercanidipine in hypertensive patients. J Hypertens 2003; 21: 1969–73.
17. Cavallini A, Terzi G. Effects of antihypertensive therapy with lercanidipine and verapamil on cardiac electrical activity in patients with hypertension: a randomized, double-blind pilot study. Curr Ther Res 2000; 61 (7): 477–87.
18. Barrios V, Navarro A, Esteras A et al. Antihypertensive efficacy and tolerability of lercanidipine in daily clinical practice. The ELYPSE Study. Eficacia de Lercanidipino y su Perfil de Seguridad. Blood Press 2002; 11: 95–100.
19. Marx A, Lichtenthal A, Milbredt C et al. Effect of anthypertensive therapy with a new third generation calcium antagonist lercanidipine on patients with concomitant diseases. J Hypertens 2004; 22 (Suppl. 2): 236.
20. Robles NR, Ocon J, Gomez CF et al. Lercanidipine in patients with chronic renal failure: The ZAFRA study. Ren Fail 2005; 27: 73–80.
21. Sarafidis P, Lasaridis A, Hatzistavri L et al. The effect of telmisartan and lercanidipine on blood pressure and insulin resistance in hypertensive patients. Rev Clin Pharmacol Pharmacokinet Int 2004; 18: 60–6.
22. Ninci MA, Magliocca R, Malliani A. Efficacy and tolerability of lercanidipine in elderly patients with mild to moderate hypertension in a placebo-controlled, double-blind study. J Cardiovasc Pharmacol 1997; 29: S40–4.
23. Poncelet P, Ribstein J, Goullard L et al. Efficacy and acceptability of lercanidipine are not age dependent in patients with essential hypertension: the AGATE study. Ann Cardiol Angeiol (Paris) 2004; 53: 123–30.
24. Martell N, Lopez-Eady MD, Castro P et al. Modifications of the pulse pressure in elderly hypertensives treated with lercanidipine. J Hypertens 2004; 22 (Suppl. 2): 121.
25. Roma J, Sobrino J, Soler-Amigo J et al. Treatment with lercanidipine during six months in hypertensive elderly patients (more than sixty years). J Hypertens 2004; 20 (Suppl. 4): 391.
26. Leonetti G, Magnani B, Pessina AC et al. Tolerability of long-term treatment with lercanidipine versus amlodipine and lacidipine in elderly hypertensives. Am J Hypertens 2002; 15: 932–40.
27. Cherubini A, Fabris F, Ferrari E et al. Comparative effects of lercanidipine, lacidipine, and nifedipine gastrointestinal therapeutic system on blood pressure and heart rate in elderly hypertensive patients: the ELderly and LErcanidipine (ELLE) study. Arch Gerontol Geriatr 2003; 37: 203–12.
28. Puig JG, Calvo C, Luurila O et al. Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebo-controlled, randomized, crossover study with four ABPM. Journal of Human Hypertension 2007; 21: 917–24.
29. Schwinger RHG, Schmidt-Mertens A. The new lipophillic calcium channel blocker lercanidipine combines high antihypertensive efficacy with low side effects. Dtsch Med Wochenschr 2002; 127 (Suppl. 1): S13.
30. Morisco C, Trimarco B. Efficacy and tolerability of lercanidipine in comparison to and in combination with atenolol in patients with mild to moderate hypertension in a double blind controlled study. J Cardiovasc Pharmacol 1997; 29 (Suppl. 2): S26–30.
31. Barbagallo M, Barbagallo Sangiorgi G. Efficacy and tolerability of lercanidipine in monotherapy in elderly patients with isolated systolic hypertension. Aging Clin Exp Res 2000; 12 (5): 375–9.
32. Fogiri R, Malamani G, Zoppi A et al. Comparative effect of lercanidipine and nifedipine gastrointestinal therapeutic system on ankle volume and subcutaneous interstitial pressure in hypertensive patients: a double-Blind, randomized, parallel-group study. Curr Ther Res 2000; 61: 850–62.
33. Borghi C, Prandin MG, Dormi A et al. Improved tolerability of the dihydropyridine calcium-channel antagonist lercanidipine: the lercanidipine challenge trial. Blood Press 2003; 12 (Suppl. 1): 1–8.
34. Veronesi M, Cicero AF, Prandin MG et al. A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice. Vasc Health Risk Manag 2007; 3: 999–1005.
2. Neaton JD, Killer L, Stamler J et al. Impact of systolic and diastolic blood pressure on cardiovascular mortality. In: Laragh JH, Brenner BM, eds. Hypertension: pathophysiology, diagnosis and management. 2nd ed. New York: Raven Press 1995; 1: 127–44.
3. Pinto E. Blood pressure and ageing. Postgrad Med J 2007; 83 (976): 109–14.
4. Pedelty L, Gorelick PB. Management of hypertension and cerebrovascular disease in the elderly. Am J Med 2008; 121 (Suppl. 8): 23–31.
5. Beckett N, Peters R, Fletcher A et al. The HYVET Study group. Treatment of hypertension in patients 80 years of age or older. N Eng J Med 2008; 358: 1887–98.
6. Lithell H, Hanson L, Skoog I et al. SCOPE study group. The study on cognition and prognosis in elderly (SCOPE). Principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.
7. Диагностика и лечение артериальной гипертензии. Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов (4-й пересмотр). Системные гипертензии 2010; 3: 5–26.
8. Kaplan N. Systolic hypertension: risk management. Hoboken. NJ: John Wiley & Sons 2004.
9. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final resultsof the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991; 265 (24): 3255–64.
10. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997; 350 (9080): 757–64.
11. Guarneri L, Angelico P, Ibba M et al. Pharmacological in vitro studies of the new 1,4-dihydropyridine calcium antagonist lercanidipine. Arzneimittelforschung 1996; 46: 15–24.
12. Angelico P, Guarneri L, Leonardi A et al. Vascular-selective effect of lercanidipine and other 1,4-dihydropyridines in isolated rabbit tissues. J Pharm Pharmacol 1999; 51: 709–14.
13. Borghi С. Lercanidipine in hypertensionVascular Health and Risk Management 2005; 1 (3): 173–82.
14. Policicchio D, Magliocca R, Malliani A. Efficacy and tolerability of lercanidipine in patients with mild to moderate essential hypertension: a comparative study with slow-release nifedipine. J Cardiovasc Pharmacol 1997; 29 (Suppl. 2): 31–5.
15. Romito R, Pansini MI, Perticone F et al. Comparative effect of of lercandipine, felodipine and nifedipine GITS on blood pressure and heart rate in patients with mild to moderate arterial hypertension: the Lercandipine in Adults (LEAD) study. J Clin Hypertens 2003; 5 (4): 249–53.
16. Pedrinelli R, Dell’Omo G, Nuti M et al. Heterogenous effect of calcium antagonists on leg oedema: a comparison of amlodipine versus lercanidipine in hypertensive patients. J Hypertens 2003; 21: 1969–73.
17. Cavallini A, Terzi G. Effects of antihypertensive therapy with lercanidipine and verapamil on cardiac electrical activity in patients with hypertension: a randomized, double-blind pilot study. Curr Ther Res 2000; 61 (7): 477–87.
18. Barrios V, Navarro A, Esteras A et al. Antihypertensive efficacy and tolerability of lercanidipine in daily clinical practice. The ELYPSE Study. Eficacia de Lercanidipino y su Perfil de Seguridad. Blood Press 2002; 11: 95–100.
19. Marx A, Lichtenthal A, Milbredt C et al. Effect of anthypertensive therapy with a new third generation calcium antagonist lercanidipine on patients with concomitant diseases. J Hypertens 2004; 22 (Suppl. 2): 236.
20. Robles NR, Ocon J, Gomez CF et al. Lercanidipine in patients with chronic renal failure: The ZAFRA study. Ren Fail 2005; 27: 73–80.
21. Sarafidis P, Lasaridis A, Hatzistavri L et al. The effect of telmisartan and lercanidipine on blood pressure and insulin resistance in hypertensive patients. Rev Clin Pharmacol Pharmacokinet Int 2004; 18: 60–6.
22. Ninci MA, Magliocca R, Malliani A. Efficacy and tolerability of lercanidipine in elderly patients with mild to moderate hypertension in a placebo-controlled, double-blind study. J Cardiovasc Pharmacol 1997; 29: S40–4.
23. Poncelet P, Ribstein J, Goullard L et al. Efficacy and acceptability of lercanidipine are not age dependent in patients with essential hypertension: the AGATE study. Ann Cardiol Angeiol (Paris) 2004; 53: 123–30.
24. Martell N, Lopez-Eady MD, Castro P et al. Modifications of the pulse pressure in elderly hypertensives treated with lercanidipine. J Hypertens 2004; 22 (Suppl. 2): 121.
25. Roma J, Sobrino J, Soler-Amigo J et al. Treatment with lercanidipine during six months in hypertensive elderly patients (more than sixty years). J Hypertens 2004; 20 (Suppl. 4): 391.
26. Leonetti G, Magnani B, Pessina AC et al. Tolerability of long-term treatment with lercanidipine versus amlodipine and lacidipine in elderly hypertensives. Am J Hypertens 2002; 15: 932–40.
27. Cherubini A, Fabris F, Ferrari E et al. Comparative effects of lercanidipine, lacidipine, and nifedipine gastrointestinal therapeutic system on blood pressure and heart rate in elderly hypertensive patients: the ELderly and LErcanidipine (ELLE) study. Arch Gerontol Geriatr 2003; 37: 203–12.
28. Puig JG, Calvo C, Luurila O et al. Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebo-controlled, randomized, crossover study with four ABPM. Journal of Human Hypertension 2007; 21: 917–24.
29. Schwinger RHG, Schmidt-Mertens A. The new lipophillic calcium channel blocker lercanidipine combines high antihypertensive efficacy with low side effects. Dtsch Med Wochenschr 2002; 127 (Suppl. 1): S13.
30. Morisco C, Trimarco B. Efficacy and tolerability of lercanidipine in comparison to and in combination with atenolol in patients with mild to moderate hypertension in a double blind controlled study. J Cardiovasc Pharmacol 1997; 29 (Suppl. 2): S26–30.
31. Barbagallo M, Barbagallo Sangiorgi G. Efficacy and tolerability of lercanidipine in monotherapy in elderly patients with isolated systolic hypertension. Aging Clin Exp Res 2000; 12 (5): 375–9.
32. Fogiri R, Malamani G, Zoppi A et al. Comparative effect of lercanidipine and nifedipine gastrointestinal therapeutic system on ankle volume and subcutaneous interstitial pressure in hypertensive patients: a double-Blind, randomized, parallel-group study. Curr Ther Res 2000; 61: 850–62.
33. Borghi C, Prandin MG, Dormi A et al. Improved tolerability of the dihydropyridine calcium-channel antagonist lercanidipine: the lercanidipine challenge trial. Blood Press 2003; 12 (Suppl. 1): 1–8.
34. Veronesi M, Cicero AF, Prandin MG et al. A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice. Vasc Health Risk Manag 2007; 3: 999–1005.
Авторы
Н.М.Чихладзе
ИКК им. А.Л.Мясникова ФГБУ РКНПК Минздрава РФ, Москва
ИКК им. А.Л.Мясникова ФГБУ РКНПК Минздрава РФ, Москва
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N.M.Chikhladze
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