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Сочетание артериальной гипертонии и ишемической болезни сердца – проблема номер один современной кардиологической практики
Сочетание артериальной гипертонии и ишемической болезни сердца – проблема номер один современной кардиологической практики
Остроумова О.Д., Дудаев В.А., Фомина В.М. Сочетание артериальной гипертонии и ишемической болезни сердца – проблема номер один современной кардиологической практики. Системные гипертензии. 2015; 1: 70–75.
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Аннотация
В статье приведены эпидемиологические данные, свидетельствующие о высокой частоте артериальной гипертонии (АГ) у больных с ишемической болезнью сердца (ИБС). Рассмотрены основные положения современных отечественных и зарубежных рекомендаций по лечению пациентов с сочетанием АГ и ИБС. Обсуждается целевой уровень артериального давления (АД) у этих больных. Рассмотрены приоритетные группы антигипертензивных препаратов, которые имеют преимущества при сочетании данных заболеваний. Особое внимание уделено проблеме вариабельности АД (ВАД) как нового фактора риска развития коронарных осложнений при АГ. Продемонстрированы возможности фиксированной комбинации периндоприла аргинин/амлодипин в снижении меж- и внутривизитной ВАД у лиц с АГ и ИБС в реальной клинической практике.
Ключевые слова: артериальная гипертония, ишемическая болезнь сердца, вариабельность артериального давления, периндоприл, амлодипин, фиксированные комбинации антигипертензивных препаратов.
Key words: arterial hypertension, ischemic heart disease, blood pressure variability, perindopril, amlodipine, fixed-dose combinations of antihypertensive agents.
Ключевые слова: артериальная гипертония, ишемическая болезнь сердца, вариабельность артериального давления, периндоприл, амлодипин, фиксированные комбинации антигипертензивных препаратов.
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Key words: arterial hypertension, ischemic heart disease, blood pressure variability, perindopril, amlodipine, fixed-dose combinations of antihypertensive agents.
Полный текст
Список литературы
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2. Шальнова С.А., Деев А.Д., Оганов Р.Г. Факторы, влияющие на смертность от сердечнососудистых заболеваний в российской популяции. Кардиоваскулярная терапия и профилактика. 2006; 2: 73–7. / Shal'nova S.A., Deev A.D., Oganov R.G. Faktory, vliiaiushchie na smertnost' ot serdechnososudistykh zabolevanii v rossiiskoi populiatsii. Kardiovaskuliarnaia terapiia i profilaktika. 2006; 2: 73–7. [in Russian]
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4. Диагностика и лечение артериальной гипертензии. Системные гипертензии. 2010; 3: 5–26. / Diagnostika i lechenie arterial'noi gipertenzii. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
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8. The European Trial on reduction of cardiac events with Perindopril in stable coronary artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782–8.
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CAMELOT study: a randomized controlled trial. JAMA 2004; 292: 2217–25.
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14. Sleight P, Redon J, Verdecchia P et al. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens 2009; 27:1360–9.
15. Bangalore S, Messerli FH, Wun C et al. Treating to New Targets Steering Committee and Investigators. J-Curve revisited: an analysis of the Treating to New Targets (TNT) Trial. J Am Coll Cardiol 2009; 53: A217.
16. Bangalore S, Qin J, Sloan S et al. What is the optimal blood pressure in patients after acute coronary syndromes?: Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial. Circulation 2010; 122: 2142–51.
17. Mancia G, Messerli F, Bakris G et al. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension 2007; 50: 299–305.
18. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342 (3): 145–53.
19. Pitt B, O’Neill B, Feldman R et al. QUIET Study Group. The Quinapril Ischemic Event Trial (QUIET) evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol 2001; 87: 1058–63.
20. The PEАСЕ Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351: 2058–68.
21. Rothwell PM, Howard SC, Dolan E et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895–905.
22. Rothwell PM, Howard SC, Dolan E et al. ASCOT-BPLA and MRC Trial Investigators. Effects of beta-blockers and calcium-channel blockers on within individual variability in blood pressure and risk of stroke. Lancet Neurol 2010; 9: 469–80.
23. Dahlof B, Sever PS, Poulter NR et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentral randomized controlled trial. Lancet 2005; 366: 895–906.
24. Oparil S. New challenges in blood pressure goal sandassessment. Nat Rev Cardiol 2011; 8: 74–5.
25. Muntner P, Shimbo D, Tonelli M et al. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension 2011; 57: 160–6.
26. Webb AJS, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in BP and risk of stroke: a systematic review and meta-analysis. Lancet 2010; 375: 906–15.
27. Rothwell PM, Webb AJS. Effect of Dose and Combination of Antihypertensives on Interindividual Blood Pressure Variability: A Systematic Review. Stroke 2011, 42: 2860–5.
28. Кобалава Ж.Д., Котовская Ю.В., Лукьянова Е.А. от имени врачей – участников программы КОНСТАНТА. Комбинированная терапия артериальной гипертонии с использованием фиксированной комбинации периндоприла аргинина/амлодипина в реальной клинической практике: организация и основные результаты программы КОНСТАНТА. Кардиология. 2013; 6: 25–34. / Kobalava Zh.D., Kotovskaia Iu.V., Luk'ianova E.A. ot imeni vrachei – uchastnikov programmy KONSTANTA. Kombinirovannaia terapiia arterial'noi gipertonii s ispol'zovaniem fiksirovannoi kombinatsii perindoprila arginina/amlodipina v real'noi klinicheskoi praktike: organizatsiia i osnovnye rezul'taty programmy KONSTANTA. Kardiologiia. 2013; 6: 25–34. [in Russian]
2. Shal'nova S.A., Deev A.D., Oganov R.G. Faktory, vliiaiushchie na smertnost' ot serdechnososudistykh zabolevanii v rossiiskoi populiatsii. Kardiovaskuliarnaia terapiia i profilaktika. 2006; 2: 73–7. [in Russian]
3. Bhatt DL, Steg PG, Ohman EM et al. REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180–9.
4. Diagnostika i lechenie arterial'noi gipertenzii. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
5. Diagnostika i lechenie stabil'noi stenokardii (vtoroi peresmotr). Kardiovaskuliarnaia terapii i profilaktika. 2008; 7 (6; Pril. 4): 3–40. [in Russian]
6. Oganov R.G., Lepakhin V.K., Fitilev S.B. i dr. Osobennosti diagnostiki i terapii stabil'noi stenokardii v Rossiiskoi Federatsii (mezhdunarodnoe issledovanie ATP – Angina Treatment Pattern). Kardiologiia. 2003; 5: 9–15. [in Russian]
7. Mancia G, Fagard R, Narkiewicz K et al. 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) J Hypertens 2013; 31: 1281–357.
8. The European Trial on reduction of cardiac events with Perindopril in stable coronary artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782–8.
9. Nissen SE, Tuzcu EM, Libby P et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the
CAMELOT study: a randomized controlled trial. JAMA 2004; 292: 2217–25.
10. Pitt B, Byington RP, Furberg CD et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation 2000; 102: 1503–10.
11. Poole-Wilson PA, Lubsen J, Kirwan BA et al. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial. Lancet 2004; 364: 849–57.
12. The PEACE Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351: 2058–68.
13. Messerli FH, Mancia G, Conti CR et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006; 144: 884–93.
14. Sleight P, Redon J, Verdecchia P et al. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens 2009; 27:1360–9.
15. Bangalore S, Messerli FH, Wun C et al. Treating to New Targets Steering Committee and Investigators. J-Curve revisited: an analysis of the Treating to New Targets (TNT) Trial. J Am Coll Cardiol 2009; 53: A217.
16. Bangalore S, Qin J, Sloan S et al. What is the optimal blood pressure in patients after acute coronary syndromes?: Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial. Circulation 2010; 122: 2142–51.
17. Mancia G, Messerli F, Bakris G et al. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension 2007; 50: 299–305.
18. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342 (3): 145–53.
19. Pitt B, O’Neill B, Feldman R et al. QUIET Study Group. The Quinapril Ischemic Event Trial (QUIET) evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol 2001; 87: 1058–63.
20. The PEАСЕ Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351: 2058–68.
21. Rothwell PM, Howard SC, Dolan E et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895–905.
22. Rothwell PM, Howard SC, Dolan E et al. ASCOT-BPLA and MRC Trial Investigators. Effects of beta-blockers and calcium-channel blockers on within individual variability in blood pressure and risk of stroke. Lancet Neurol 2010; 9: 469–80.
23. Dahlof B, Sever PS, Poulter NR et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentral randomized controlled trial. Lancet 2005; 366: 895–906.
24. Oparil S. New challenges in blood pressure goal sandassessment. Nat Rev Cardiol 2011; 8: 74–5.
25. Muntner P, Shimbo D, Tonelli M et al. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension 2011; 57: 160–6.
26. Webb AJS, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in BP and risk of stroke: a systematic review and meta-analysis. Lancet 2010; 375: 906–15.
27. Rothwell PM, Webb AJS. Effect of Dose and Combination of Antihypertensives on Interindividual Blood Pressure Variability: A Systematic Review. Stroke 2011, 42: 2860–5.
28. Kobalava Zh.D., Kotovskaia Iu.V., Luk'ianova E.A. ot imeni vrachei – uchastnikov programmy KONSTANTA. Kombinirovannaia terapiia arterial'noi gipertonii s ispol'zovaniem fiksirovannoi kombinatsii perindoprila arginina/amlodipina v real'noi klinicheskoi praktike: organizatsiia i osnovnye rezul'taty programmy KONSTANTA. Kardiologiia. 2013; 6: 25–34. [in Russian]
2. Шальнова С.А., Деев А.Д., Оганов Р.Г. Факторы, влияющие на смертность от сердечнососудистых заболеваний в российской популяции. Кардиоваскулярная терапия и профилактика. 2006; 2: 73–7. / Shal'nova S.A., Deev A.D., Oganov R.G. Faktory, vliiaiushchie na smertnost' ot serdechnososudistykh zabolevanii v rossiiskoi populiatsii. Kardiovaskuliarnaia terapiia i profilaktika. 2006; 2: 73–7. [in Russian]
3. Bhatt DL, Steg PG, Ohman EM et al. REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180–9.
4. Диагностика и лечение артериальной гипертензии. Системные гипертензии. 2010; 3: 5–26. / Diagnostika i lechenie arterial'noi gipertenzii. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
5. Диагностика и лечение стабильной стенокардии (второй пересмотр). Кардиоваскулярная терапии и профилактика. 2008; 7 (6; Прил. 4): 3–40. / Diagnostika i lechenie stabil'noi stenokardii (vtoroi peresmotr). Kardiovaskuliarnaia terapii i profilaktika. 2008; 7 (6; Pril. 4): 3–40. [in Russian]
6. Оганов Р.Г., Лепахин В.К., Фитилев С.Б. и др. Особенности диагностики и терапии стабильной стенокардии в Российской Федерации (международное исследование ATP – Angina Treatment Pattern). Кардиология. 2003; 5: 9–15. / Oganov R.G., Lepakhin V.K., Fitilev S.B. i dr. Osobennosti diagnostiki i terapii stabil'noi stenokardii v Rossiiskoi Federatsii (mezhdunarodnoe issledovanie ATP – Angina Treatment Pattern). Kardiologiia. 2003; 5: 9–15. [in Russian]
7. Mancia G, Fagard R, Narkiewicz K et al. 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) J Hypertens 2013; 31: 1281–357.
8. The European Trial on reduction of cardiac events with Perindopril in stable coronary artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782–8.
9. Nissen SE, Tuzcu EM, Libby P et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the
CAMELOT study: a randomized controlled trial. JAMA 2004; 292: 2217–25.
10. Pitt B, Byington RP, Furberg CD et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation 2000; 102: 1503–10.
11. Poole-Wilson PA, Lubsen J, Kirwan BA et al. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial. Lancet 2004; 364: 849–57.
12. The PEACE Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351: 2058–68.
13. Messerli FH, Mancia G, Conti CR et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006; 144: 884–93.
14. Sleight P, Redon J, Verdecchia P et al. Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. J Hypertens 2009; 27:1360–9.
15. Bangalore S, Messerli FH, Wun C et al. Treating to New Targets Steering Committee and Investigators. J-Curve revisited: an analysis of the Treating to New Targets (TNT) Trial. J Am Coll Cardiol 2009; 53: A217.
16. Bangalore S, Qin J, Sloan S et al. What is the optimal blood pressure in patients after acute coronary syndromes?: Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial. Circulation 2010; 122: 2142–51.
17. Mancia G, Messerli F, Bakris G et al. Blood pressure control and improved cardiovascular outcomes in the International Verapamil SR-Trandolapril Study. Hypertension 2007; 50: 299–305.
18. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342 (3): 145–53.
19. Pitt B, O’Neill B, Feldman R et al. QUIET Study Group. The Quinapril Ischemic Event Trial (QUIET) evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol 2001; 87: 1058–63.
20. The PEАСЕ Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351: 2058–68.
21. Rothwell PM, Howard SC, Dolan E et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375: 895–905.
22. Rothwell PM, Howard SC, Dolan E et al. ASCOT-BPLA and MRC Trial Investigators. Effects of beta-blockers and calcium-channel blockers on within individual variability in blood pressure and risk of stroke. Lancet Neurol 2010; 9: 469–80.
23. Dahlof B, Sever PS, Poulter NR et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentral randomized controlled trial. Lancet 2005; 366: 895–906.
24. Oparil S. New challenges in blood pressure goal sandassessment. Nat Rev Cardiol 2011; 8: 74–5.
25. Muntner P, Shimbo D, Tonelli M et al. The relationship between visit-to-visit variability in systolic blood pressure and all-cause mortality in the general population: findings from NHANES III, 1988 to 1994. Hypertension 2011; 57: 160–6.
26. Webb AJS, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in BP and risk of stroke: a systematic review and meta-analysis. Lancet 2010; 375: 906–15.
27. Rothwell PM, Webb AJS. Effect of Dose and Combination of Antihypertensives on Interindividual Blood Pressure Variability: A Systematic Review. Stroke 2011, 42: 2860–5.
28. Кобалава Ж.Д., Котовская Ю.В., Лукьянова Е.А. от имени врачей – участников программы КОНСТАНТА. Комбинированная терапия артериальной гипертонии с использованием фиксированной комбинации периндоприла аргинина/амлодипина в реальной клинической практике: организация и основные результаты программы КОНСТАНТА. Кардиология. 2013; 6: 25–34. / Kobalava Zh.D., Kotovskaia Iu.V., Luk'ianova E.A. ot imeni vrachei – uchastnikov programmy KONSTANTA. Kombinirovannaia terapiia arterial'noi gipertonii s ispol'zovaniem fiksirovannoi kombinatsii perindoprila arginina/amlodipina v real'noi klinicheskoi praktike: organizatsiia i osnovnye rezul'taty programmy KONSTANTA. Kardiologiia. 2013; 6: 25–34. [in Russian]
________________________________________________
2. Shal'nova S.A., Deev A.D., Oganov R.G. Faktory, vliiaiushchie na smertnost' ot serdechnososudistykh zabolevanii v rossiiskoi populiatsii. Kardiovaskuliarnaia terapiia i profilaktika. 2006; 2: 73–7. [in Russian]
3. Bhatt DL, Steg PG, Ohman EM et al. REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180–9.
4. Diagnostika i lechenie arterial'noi gipertenzii. Systemic Hypertension. 2010; 3: 5–26. [in Russian]
5. Diagnostika i lechenie stabil'noi stenokardii (vtoroi peresmotr). Kardiovaskuliarnaia terapii i profilaktika. 2008; 7 (6; Pril. 4): 3–40. [in Russian]
6. Oganov R.G., Lepakhin V.K., Fitilev S.B. i dr. Osobennosti diagnostiki i terapii stabil'noi stenokardii v Rossiiskoi Federatsii (mezhdunarodnoe issledovanie ATP – Angina Treatment Pattern). Kardiologiia. 2003; 5: 9–15. [in Russian]
7. Mancia G, Fagard R, Narkiewicz K et al. 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) J Hypertens 2013; 31: 1281–357.
8. The European Trial on reduction of cardiac events with Perindopril in stable coronary artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782–8.
9. Nissen SE, Tuzcu EM, Libby P et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the
CAMELOT study: a randomized controlled trial. JAMA 2004; 292: 2217–25.
10. Pitt B, Byington RP, Furberg CD et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation 2000; 102: 1503–10.
11. Poole-Wilson PA, Lubsen J, Kirwan BA et al. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial. Lancet 2004; 364: 849–57.
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Авторы
О.Д.Остроумова*1,2, В.А.Дудаев1, В.М.Фомина1
1 ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ostroumova.olga@mail.ru
1 A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, Delegatskaya ul., d. 20, str. 1;
2 I.M.Sechenov the First Moscow Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, Trubetskaya ul., d. 8, str. 2
*ostroumova.olga@mail.ru
1 ГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1;
2 ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ostroumova.olga@mail.ru
________________________________________________
1 A.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, Delegatskaya ul., d. 20, str. 1;
2 I.M.Sechenov the First Moscow Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, Trubetskaya ul., d. 8, str. 2
*ostroumova.olga@mail.ru
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