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b-Адреноблокаторы при сердечно-сосудистых заболеваниях: фокус на метопролол
b-Адреноблокаторы при сердечно-сосудистых заболеваниях: фокус на метопролол
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Аннотация
В статье представлены данные о терапевтической эффективности b-адреноблокаторов при ишемической болезни сердца, хронической сердечной недостаточности, артериальной гипертонии. Рассмотрены основные механизмы фармакологического действия препаратов этого класса. В сравнении с другими b-адреноблокаторами обсуждаются фармакодинамические и фармакокинетические особенности метопролола сукцината пролонгированного действия, его преимущества перед короткодействующими препаратами, его влияние на течение хронической сердечной недостаточности. На основании результатов рандомизированных клинических исследований сделан вывод о высокой терапевтической эффективности и безопасности метопролола сукцината с пролонгированным действием.
Ключевые слова: b-адреноблокаторы, метопролола сукцинат, ишемическая болезнь сердца, хроническая сердечная недостаточность, артериальная гипертония.
Key words: beta-adrenergic blocking agent, metoprololsuccinate, ischemic heart disease, chronic cardiac failure, arterial hypertension.
Ключевые слова: b-адреноблокаторы, метопролола сукцинат, ишемическая болезнь сердца, хроническая сердечная недостаточность, артериальная гипертония.
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Key words: beta-adrenergic blocking agent, metoprololsuccinate, ischemic heart disease, chronic cardiac failure, arterial hypertension.
Полный текст
Список литературы
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28. Yusuf S, Peto R, Lewis J et al. Beta blocade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27 (5): 335–71.
29. Herlitz J, Dellborg M, Karlson BW et al. Long-term mortality after acute myocardial infarction in relation to prescribed dosages of a beta-blocker at hospital discharge. Cardiovasc Drugs Ther 2000; 14 (6): 589–95.
30. Viskin S, Kitzis I, Lev E et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. J Am Coll Cardiol 1995; 25: 1327–32.
31. Kjeksus JK, Gilpin E, Cali G et al. Diabetic patients and beta–blockers after acute myocardial infarction. Eur Heart J 1990: 11: 43–50.
32. Chen J, Marciniac TA, Radford MJ et al. Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients. JACC 1999; 34: 1388–94.
33. Gottlieb S. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339 (8): 489–97.
34. Andersson B, Aberg J. The effect on heart rate of immediate and slow-release metoprolol in patients with chronic heart failure [abstr. 1110–10]. J Am Coll Cardiol 1999; 33 (Suppl. A): A183–4.
35. Белоусов Ю.Б., Леонова М.В., Манешина О.А. и др. Метопролола сукцинат и тартрат: влияет ли соль на эффективность препарата? Фарматека. 2006; 19 (134): 14–9.
36. Jaattela A, Baandrup S, Houtzagers J, Westergren G. The efficacy of low dose metoprolol CR/ZOK in mild hypertension and in elderly patients with mild to moderate hypertension. J Clin Pharmacol 1990; 30 (Suppl. 2): S66–71.
37. Klein G, Berger J, Olsson G, Menzel T. A double-blind comparison of metoprolol CR/ZOK 50 mg and atenolol 50 mg once daily for uncomplicated hypertension. J Clin Pharmacol 1990; 30 (Suppl. 2): S72–7.
38. Omvik P, Leer J, Istad H, Westergren G. Equal Efficacy and Improved Tolerability with 50 mg Controlled-Release Metoprolol Compared with 100 mg Conventional Metoprolol in Hypertensive Patients. Am J Ther 1994; 1 (1): 65–73.
39. Wikstrand J, Warnold I, Tuomilehto J et al. Metoprolol versus thiazide diuretics in hypertension. Morbidity results from the MAPHY Study. Hypertension 1991; 17 (4): 579–88.
40. 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 (13): 1721–6.
41. Wiklund O, Hulthe J, Wikstrand J et al. Effect of Controlled Release/Extended Release Metoprolol on Carotid Intima–Media Thickness in Patients With Hypercholesterolemia: A 3-Year Randomized Study. Stroke 2002; 33 (2): 572–57.
42. Singh BN. CIBIS, MERIT–HF and COPERNICUS trial outcomes: do they complete the chapter on beta-adrenergic blockers as antiarrhytmic and antifibrillatory drugs? J Cardiovasc Pharmacol Ther 2001; 6 (2): 107–10.
43. Hjalmarson A. Effects of beta-blockade on sudden cardiac death during acute myocardial infarction and the postinfarction period. Am J Cardiol 1997; 80 (9B): 35J–9J.
44. Nuttall SL, Toescu V, Kendall MJ. Beta-blockade after myocardial infarction. BMJ 2000; 320: 581–8.
45. Moss AJ, Zareba W, Hall WJ et al. Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation 2000; 101 (6): 616–23.
46. Viskin S, Fish R. Prevention of ventricular arrhythmias in the congenital long QT syndrome. Curr Cardiol Rep 2000; 2 (6): 492–7.
47. Bouzamondo A, Hulot JS, Sanchez P et al. Beta-blocker treatment in heart failure. Fund & Clin Pharmacol 2001; 15: 95–109.
48. Sharpe N. Benefit of beta-blockers for heart failure: proven in 1999. Lancet 1999; 353: 1988–9.
49. Bristow MR. Beta-adrenergic blockade in chronic heart failure. Circulation 2000; 101: 558–69.
50. Lonn E, McKelvie R. Drug treatment in heart failure. BMJ 2000; 320: 1188–92.
51. Арутюнов Г.П. Бета-блокаторы и сердечная недостаточность. Сердечная недостаточность. 2002; 1: 27–8.
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53. ESC Guidelines for diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2012; 33: 1787–847.
54. MERIT–HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT–HF). Lancet 1999; 353: 2001–7.
55. Goldstein S, Fagerberg B, Hjalmarson A et al. Metoprolol controlled release extended release in patients with severe heart failure. Analysis of the experience in the MERIT–HF study. J Am Coll Cardiol 2001; 38: 932–8.
56. Deedwania PC, Gottlieb S, Ghali JK et al. Efficacy, safety and tolerability of betaadrenergic blockade with metoprolol CR/XL in elderly patients with heart failure. Eur Heart J 2004; 25: 1300–9.
57. Wikstrand J, Hjalmarson A, Waagstein F et al. MERIT–HF Study Group. Dose of metoprolol CR/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR/XL randomized intervention trial in chronic heart failure (MERIT–HF). J Am Coll Cardiol 2002; 40 (3): 491–8.
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2. Mancia G, Fagard R, Narkiewicz K et al. Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31: 1925–38.
3. Документ о соглашении экспертов по блокаторам b-адренергических рецепторов. Рабочая группа Европейского общества кардиологов по бета-блокаторам. Кардиоваск. терапия и профилактика. 2005; 1: 99–124.
4. Лупанов В.П. Лечение больных ишемической болезнью сердца после коронарного шунтирования и чрескожных коронарных вмешательств. Атмосфера. Кардиология. 2007; 3: 18–24.
5. Bangalore S, Wild D, Parkar S et al. Beta-blockers for primary prevention of heart failure in patients with hypertension: insights from a meta-analysis. JACC 2008; 52: 1062–72.
6. Nuttall SL, Routledge HC, Kendall MJ. A comparison of the beta1-selectivity of three beta-blockers. J Clin Pharmacol 2003; 28 (3): 179–86.
7. Sandberg A, Abrahamsson B, Regardh CG et al. Pharmacokinetic and biopharmaceutic aspects of once daily treatment with metoprolol CR/ZOK: a review article. J Clin Pharmacol 1990; 30 (Suppl. 2): S2–16.
8. Чазова И.Е. b-Адреноблокаторы: место их применения при артериальной гипертонии в современных условиях. Системные гипертензии. 2007; 2: 4–7.
9. Карпов Ю.А., Шубина А.Т. b-Блокаторы сегодня: на передовых рубежах в борьбе с сердечно-сосудистыми заболеваниями. Рус. мед. журн. 2004; 12 (15): 901–4.
10. Reiter MJ. Cardiovascular drug class specificity: b-blockers. Progressin Cardiovasс Dis 2004; 47 (1): 11–33.
11. Толпыгина С.Н., Марцевич C.Ю. Эффективность и безопасность высоких доз метопролола пролонгированного действия при лечении пациентов со стабильным течением ишемической болезни сердца. Рацион. фармакотерапия в кардиологии. 2008; 5: 46–52.
12. Savonitto S, Ardissiono D, Egstrup K et al. Combination therapy with metoprolol and nifedipine versus monotherapy in patients with stable angina pectoris. Results of the international multicenter angina exercise (IMAGE) study. J Am Coll Cardiol 1996; 27 (2): 311–6.
13. Rehnqvist N, Hjemdahl P, Billing E et al. Treatment of stable angina pectoris with calcium antagonists and beta-blockers. The APSIS study. Angina Prognosis study in Stockholm. Cardiologia 1995; 40 (12 Suppl. 1): 301.
14. Ardissino D, Savonitto S, Egstrup K et al. Selection of medical treatment in stable angina pectoris: results of the InternationalMulticenter Angina Exercise (IMAGE) study. J Am Coll Cardiol 1995; 25: 1516–21.
15. Egstrup K, Gundersen T, Härkönen R et al. The antianginal efficacy and tolerability of controlled-release metoprolol once daily: A comparison with conventional metoprolol tablets twice daily Eur J Clin Pharmacol 1988; (Suppl. 33): S45–9.
16. Hjalmarson A, Elmfeldt D, Herlitz J et al. Effect on mortality of metoprolol in acute myocardial infarction: A double-blind randomized trial. Lancet 1981; 2 (8251): 823–7.
17. Herlitz J, Waagstein F, Lindqvist J et al. Effect of metoprolol on the prognosis for patients with suspected acute myocardial infarction and indirect signs of congestive heart failure (subgroup analysis of the Gеteborg Metoprolol Trial). Am J Cardiol 1997; 80 (9B): 40J–44J.
18. The MIAMI Trial Research Group: Metoprolol in acute myocardial infarction (MIAMI): A randomized placebo-controlled international trial. Eur Heart J 1985; 6 (3): 199–226.
19. Chen ZM, Pan HC, Chen YP et al. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366 (9497): 1622–32.
20. Guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2008; 51 (2): 210–47.
21. Van de Werf F, Bax J, Betriu A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008; 29 (23): 2909–45.
22. Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST на ЭКГ. Под ред. Р.Г.Оганова, М.Н.Мамедова. Национ. клин. рекомендации. М.: МЕДИ Экспо, 2009; с. 167–230.
23. Hjalmarson A, Herlitz J, Holmberg S еt al. The Göteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction. Circulation 1983; 67 (6 Pt 2): I26–32.
24. Yusuf S, Lessem J, Jha P, Lonn E. Primary and secondary prevention of myocardial infarction and strokes: an update of randomly allocated, controlled trials. J Hypertens (Suppl.) 1993; 11 (4): S61–73.
25. Freemantle N, Cleland J, Young P et al. Beta-blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999; 318 (7200): 1730–7.
26. Olsson G, Rehnqvist N, Sjögren A et al. Long-term treatment with metoprolol after myocardial infarction: effect on 3 year mortality and morbidity. J Am Coll Cardiol 1985; 5 (6): 1428–37.
27. Manger Cats V, van Capelle FLJ, Lie KJ, Durrer D. The Amsterdam metoprolol trial. Effect of treatment with metoprolol on first year mortality in a single-centre study with low placebo mortality rate after myocardial infarction (Abstract). Drugs 1985; 29 (Suppl. 1): 8.
28. Yusuf S, Peto R, Lewis J et al. Beta blocade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27 (5): 335–71.
29. Herlitz J, Dellborg M, Karlson BW et al. Long-term mortality after acute myocardial infarction in relation to prescribed dosages of a beta-blocker at hospital discharge. Cardiovasc Drugs Ther 2000; 14 (6): 589–95.
30. Viskin S, Kitzis I, Lev E et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. J Am Coll Cardiol 1995; 25: 1327–32.
31. Kjeksus JK, Gilpin E, Cali G et al. Diabetic patients and beta–blockers after acute myocardial infarction. Eur Heart J 1990: 11: 43–50.
32. Chen J, Marciniac TA, Radford MJ et al. Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients. JACC 1999; 34: 1388–94.
33. Gottlieb S. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339 (8): 489–97.
34. Andersson B, Aberg J. The effect on heart rate of immediate and slow-release metoprolol in patients with chronic heart failure [abstr. 1110–10]. J Am Coll Cardiol 1999; 33 (Suppl. A): A183–4.
35. Белоусов Ю.Б., Леонова М.В., Манешина О.А. и др. Метопролола сукцинат и тартрат: влияет ли соль на эффективность препарата? Фарматека. 2006; 19 (134): 14–9.
36. Jaattela A, Baandrup S, Houtzagers J, Westergren G. The efficacy of low dose metoprolol CR/ZOK in mild hypertension and in elderly patients with mild to moderate hypertension. J Clin Pharmacol 1990; 30 (Suppl. 2): S66–71.
37. Klein G, Berger J, Olsson G, Menzel T. A double-blind comparison of metoprolol CR/ZOK 50 mg and atenolol 50 mg once daily for uncomplicated hypertension. J Clin Pharmacol 1990; 30 (Suppl. 2): S72–7.
38. Omvik P, Leer J, Istad H, Westergren G. Equal Efficacy and Improved Tolerability with 50 mg Controlled-Release Metoprolol Compared with 100 mg Conventional Metoprolol in Hypertensive Patients. Am J Ther 1994; 1 (1): 65–73.
39. Wikstrand J, Warnold I, Tuomilehto J et al. Metoprolol versus thiazide diuretics in hypertension. Morbidity results from the MAPHY Study. Hypertension 1991; 17 (4): 579–88.
40. 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 (13): 1721–6.
41. Wiklund O, Hulthe J, Wikstrand J et al. Effect of Controlled Release/Extended Release Metoprolol on Carotid Intima–Media Thickness in Patients With Hypercholesterolemia: A 3-Year Randomized Study. Stroke 2002; 33 (2): 572–57.
42. Singh BN. CIBIS, MERIT–HF and COPERNICUS trial outcomes: do they complete the chapter on beta-adrenergic blockers as antiarrhytmic and antifibrillatory drugs? J Cardiovasc Pharmacol Ther 2001; 6 (2): 107–10.
43. Hjalmarson A. Effects of beta-blockade on sudden cardiac death during acute myocardial infarction and the postinfarction period. Am J Cardiol 1997; 80 (9B): 35J–9J.
44. Nuttall SL, Toescu V, Kendall MJ. Beta-blockade after myocardial infarction. BMJ 2000; 320: 581–8.
45. Moss AJ, Zareba W, Hall WJ et al. Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation 2000; 101 (6): 616–23.
46. Viskin S, Fish R. Prevention of ventricular arrhythmias in the congenital long QT syndrome. Curr Cardiol Rep 2000; 2 (6): 492–7.
47. Bouzamondo A, Hulot JS, Sanchez P et al. Beta-blocker treatment in heart failure. Fund & Clin Pharmacol 2001; 15: 95–109.
48. Sharpe N. Benefit of beta-blockers for heart failure: proven in 1999. Lancet 1999; 353: 1988–9.
49. Bristow MR. Beta-adrenergic blockade in chronic heart failure. Circulation 2000; 101: 558–69.
50. Lonn E, McKelvie R. Drug treatment in heart failure. BMJ 2000; 320: 1188–92.
51. Арутюнов Г.П. Бета-блокаторы и сердечная недостаточность. Сердечная недостаточность. 2002; 1: 27–8.
52. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). 2013.
53. ESC Guidelines for diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2012; 33: 1787–847.
54. MERIT–HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT–HF). Lancet 1999; 353: 2001–7.
55. Goldstein S, Fagerberg B, Hjalmarson A et al. Metoprolol controlled release extended release in patients with severe heart failure. Analysis of the experience in the MERIT–HF study. J Am Coll Cardiol 2001; 38: 932–8.
56. Deedwania PC, Gottlieb S, Ghali JK et al. Efficacy, safety and tolerability of betaadrenergic blockade with metoprolol CR/XL in elderly patients with heart failure. Eur Heart J 2004; 25: 1300–9.
57. Wikstrand J, Hjalmarson A, Waagstein F et al. MERIT–HF Study Group. Dose of metoprolol CR/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR/XL randomized intervention trial in chronic heart failure (MERIT–HF). J Am Coll Cardiol 2002; 40 (3): 491–8.
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Авторы
Г.А.Барышникова, И.И.Степанова, Н.А.Кудрявцева
ФГБУ Учебно-научный медицинский центр Управления делами Президента РФ
ФГБУ Учебно-научный медицинский центр Управления делами Президента РФ
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