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Особенности лечения артериальной гипертонии у женщин в перименопаузе
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Аннотация
Важнейшими причинами инвалидности у женщин являются хроническая сердечная недостаточность, развившаяся на фоне артериальной гипертонии (АГ), и мозговой инсульт. Вместе с тем распространенность АГ среди женщин в постменопаузе значительно выше, чем среди мужчин. У женщин АГ чаще развивается на фоне метаболических нарушений, в частности метаболического синдрома. В связи с этим препаратами выбора для лечения АГ у женщин в перименопаузе являются ингибиторы ангиотензинпревращающего фермента и блокаторы рецепторов ангиотензина. При необходимости комбинированной антигипертензивной терапии препаратами выбора могут служить агонисты имидазолиновых рецепторов, в частности моксонидин. Применение моксонидина у этой категории пациенток оправдано особенностями фармакологического действия препарата (снижение симпатической гиперактивации), высокой антигипертензивной эффективностью, а также дополнительными позитивными эффектами в отношении массы тела и основных метаболических показателей.
Ключевые слова: метаболический синдром, артериальная гипертония, ожирение, моксонидин, менопауза.
Ключевые слова: метаболический синдром, артериальная гипертония, ожирение, моксонидин, менопауза.
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Major causes of disability among women are chronic heart failure, developed on arterial hypertension (AH) and cerebral stroke. However, the prevalence of AH among postmenopausal women is significantly higher than for men. Women are more likely to develop AH with metabolic disorders, including metabolic syndrome. Therefore, the drugs of choice to treat AH in women in perimenopauseare ACE inhibitors and Angiotensin II Receptor Blocker. If necessary, combination antihypertensive treatment drugs of choice are agonistsimidazoline receptors, such as moxonidine. The use of this category of patients havemoxonidine action justified by the features of the pharmacological action of this drug (decrease in sympathetic hyperactivity), high efficiency, antihypertensive as well as additional positive effects on body weight and metabolic parameters.
Key words: metabolic syndrome, hypertension, obesity, moxonidine menopause.
Полный текст
Список литературы
1. WHO. The World health statistics 2012 report: URL: http://who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf (дата обращения: 22.02.2012).
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4. Guthrie JR, Dennerstein L, Taffe JR et al. The menopausal transition: a 9-year prospective population-based study. The Melbourne Women’s Midlife Health Project. Climacteric 2004; 7: 375–89.
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6. Piatti PM, Monti LD et al. Forearm insulin-and-non-insulin mediated glucose uptake and muscle metabolism in man: role of free fatty acids and blood glucose levels. Metab Clin Exp 1991; 40: 926–33.
7. Ferrannini E, Buzzigoli G, Bonadonna R et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350–7.
8. Rowe JR, Young JB, Minaker KL et al. Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man. Diabetes 1981; 30: 219–25.
9. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension 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 2013; doi: 10.1093/eurheartj/eht151.
10. Rosen P, Ohhy P, Gleichmann H. Experimental benefit of moxonidine on glucose metabolism and insulin secretion in the fructose-ied rat. J Hypertens 1997; Suppl. 15: S31–S38.
11. Ernsberger P. Pharmacology of moxonidine: and I1-imidazoline receptor agonist. J Cardiovasc Pharmacol 2000; 35 (7 Suppl. 4): S27–41.
12. Chazova I, Schlaich MP. Improved hypertension control with the imidazoline agonist moxonidine in a multinational metabolic syndrome population: principal results of the MERSY Study. Intern J Hypertens 2013; 1–9; doi:10.1155/2013/541689
2. Peterson S, Peto V, Rayner M et al. European Cardiovascular Disease Statistics, 2nd edn. British Heart Foundation 2005.
3. Pyorala K, Lehto S, De Bacquer D et al. EUROASPIRE I Group; EUROASPIRE II Group. Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I AND II surveys. Diabetologia 2004; 47: 1257–65.
4. Guthrie JR, Dennerstein L, Taffe JR et al. The menopausal transition: a 9-year prospective population-based study. The Melbourne Women’s Midlife Health Project. Climacteric 2004; 7: 375–89.
5. Pasquali R, Casimirri F, Venturoli S et al. Body fat distribution has weight-independent effects on clinical, hormonal, and metabolic features of women with polycystic ovary syndrome. Metabolism 1994; 43: 706–13.
6. Piatti PM, Monti LD et al. Forearm insulin-and-non-insulin mediated glucose uptake and muscle metabolism in man: role of free fatty acids and blood glucose levels. Metab Clin Exp 1991; 40: 926–33.
7. Ferrannini E, Buzzigoli G, Bonadonna R et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350–7.
8. Rowe JR, Young JB, Minaker KL et al. Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man. Diabetes 1981; 30: 219–25.
9. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension 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 2013; doi: 10.1093/eurheartj/eht151.
10. Rosen P, Ohhy P, Gleichmann H. Experimental benefit of moxonidine on glucose metabolism and insulin secretion in the fructose-ied rat. J Hypertens 1997; Suppl. 15: S31–S38.
11. Ernsberger P. Pharmacology of moxonidine: and I1-imidazoline receptor agonist. J Cardiovasc Pharmacol 2000; 35 (7 Suppl. 4): S27–41.
12. Chazova I, Schlaich MP. Improved hypertension control with the imidazoline agonist moxonidine in a multinational metabolic syndrome population: principal results of the MERSY Study. Intern J Hypertens 2013; 1–9; doi:10.1155/2013/541689
________________________________________________
1. WHO. The World health statistics 2012 report: URL: http://who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf (дата обращения: 22.02.2012).
2. Peterson S, Peto V, Rayner M et al. European Cardiovascular Disease Statistics, 2nd edn. British Heart Foundation 2005.
3. Pyorala K, Lehto S, De Bacquer D et al. EUROASPIRE I Group; EUROASPIRE II Group. Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I AND II surveys. Diabetologia 2004; 47: 1257–65.
4. Guthrie JR, Dennerstein L, Taffe JR et al. The menopausal transition: a 9-year prospective population-based study. The Melbourne Women’s Midlife Health Project. Climacteric 2004; 7: 375–89.
5. Pasquali R, Casimirri F, Venturoli S et al. Body fat distribution has weight-independent effects on clinical, hormonal, and metabolic features of women with polycystic ovary syndrome. Metabolism 1994; 43: 706–13.
6. Piatti PM, Monti LD et al. Forearm insulin-and-non-insulin mediated glucose uptake and muscle metabolism in man: role of free fatty acids and blood glucose levels. Metab Clin Exp 1991; 40: 926–33.
7. Ferrannini E, Buzzigoli G, Bonadonna R et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350–7.
8. Rowe JR, Young JB, Minaker KL et al. Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man. Diabetes 1981; 30: 219–25.
9. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension 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 2013; doi: 10.1093/eurheartj/eht151.
10. Rosen P, Ohhy P, Gleichmann H. Experimental benefit of moxonidine on glucose metabolism and insulin secretion in the fructose-ied rat. J Hypertens 1997; Suppl. 15: S31–S38.
11. Ernsberger P. Pharmacology of moxonidine: and I1-imidazoline receptor agonist. J Cardiovasc Pharmacol 2000; 35 (7 Suppl. 4): S27–41.
12. Chazova I, Schlaich MP. Improved hypertension control with the imidazoline agonist moxonidine in a multinational metabolic syndrome population: principal results of the MERSY Study. Intern J Hypertens 2013; 1–9; doi:10.1155/2013/541689
Авторы
Ю.В.Жернакова*, И.Е.Чазова
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ РКНПК Минздрава России, Москва
*juli001@mail.ru
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ РКНПК Минздрава России, Москва
*juli001@mail.ru
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Yu.V.Zhernakova*, I.E.Chazova
*juli001@mail.ru
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