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Диуретики в составе комбинированной антигипертензивной терапии: фокус на прогноз
Диуретики в составе комбинированной антигипертензивной терапии: фокус на прогноз
Чазова И.Е., Мартынюк Т.В. Диуретики в составе комбинированной антигипертензивной терапии: фокус на прогноз. Системные гипертензии. 2016; 13 (2): 6–10.
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Аннотация
В современной терапии артериальной гипертонии (АГ) тиазидные диуретики наряду с b-адреноблокаторами, антагонистами кальция, ингибиторами ангиотензинпревращающего фермента и блокаторами рецепторов ангиотензина рассматриваются для начальной и поддерживающей антигипертензивной терапии в виде моно- или комбинированной терапии. Пять указанных классов препаратов обладают сопоставимой антигипертензивной эффективностью и доказанным влиянием на прогноз в соответствии с результатами рандомизированных контролируемых клинических исследований. Наибольшее распространение в широкой клинической практике для лечения больных АГ получили тиазидные (тиазидоподобные) диуретики. Наиболее мощной доказательной базой среди диуретиков в отношении влияния на прогноз имеет хлорталидон (ХТД). В статье представлены данные рандомизированных плацебо-контролируемых и сравнительных исследований ХТД и гидрохлоротиазида при АГ. Показано, что диуретики являются наиболее оправданным компонентом комбинированной терапии. Применение новой фиксированной комбинации ХТД в сочетании с азилсартана медоксомилом в нашей стране позволит улучшить возможности эффективного лечения этой категории больных.
Ключевые слова: артериальная гипертензия, диуретики, хлорталидон, гидрохлоротиазид, азилсартан, монотерапия, комбинированная терапия.
Key words: arterial hypertension, diuretics, chlortalidone, hydrochlorothiazide, azilsartan, monotherapy, combination therapy.
Ключевые слова: артериальная гипертензия, диуретики, хлорталидон, гидрохлоротиазид, азилсартан, монотерапия, комбинированная терапия.
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Key words: arterial hypertension, diuretics, chlortalidone, hydrochlorothiazide, azilsartan, monotherapy, combination therapy.
Полный текст
Список литературы
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6. Veterans Administration Cooperative Study on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. JAMA 1967; 202: 116–22.
7. SHEP Cooperative Research Study Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3255–64.
8. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium-channel blocker vs diuretic: The Antihypertensive an Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97.
9. Peterzan MA, Hardy R, Chaturvedi N, Hughes AD. Meta-analysis of dose-response relationships for hydrochlorothiazide, chlorthalidone, and bendroflumethiazide on blood pressure, serum potassium, and urate. Hypertension 2012; 59: 1104–9.
10. Psaty BM, Lumley T, Furberg CD et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003; 289: 2534–44.
11. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: Effects of various classes of antihypertensive drugs-overview and meta-analyses. J Hypertens 2015; 33 (2): 195–211.
12. Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982; 248: 1465–77.
13. Carter BL, Ernst ME, Cohen JD. Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension 2004; 43: 4–9.
14. Кurtz TW. Chlorthalidone: don’t call it “thiazide-like” anymore. Hypertension 2010; 56: 335–7.
15. Liebson PR, Grandits GA, Dianzumba S et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation 1995; 91 (3): 698–706.
16. Materson BJ, Oster JR, Michael UF et al. Dose response to chlorthalidone in patients with mild hypertension, efficacy of a lower dose. Clin Pharmacol Ther 1978; 24: 192–8.
17. Khosla N, Chua DY, Elliott WJ, Bakris GL. Are chlorthalidone and hydrochlorothiazide equivalent blood-pressure-lowering medications? J Clin Hypertens (Greenwich) 2005; 7 (6): 354–6.
18. Musini V, Nazer M, Bassett K et al. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev 2014; 5: CD003824; doi: 10.1002/14651858.CD003824.pub2.
19. Недогода С.В. Азилсартан: расширит ли он возможности лечения артериальной гипертензии? Кардиология. 2015: 4: 97–100. / Nedogoda S.V. Azilsartan: rasshirit li on vozmozhnosti lecheniia arterial'noĭ gipertenzii? Kardiologiia. 2015: 4: 97–100. [in Russian]
20. Bakris G, Sica D, White WB et al. Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil. Am J Med 2012; 125: 1229. e1–1229.e10.
21. Calhoun DA, Jones D, Textor S et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117: e510–e526.
2. 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). J Hypertens 2013; 31: 1281–357.
3. Leonova M.V., Shteinberg L.L., Belousov D.Iu. i dr. Rezul'taty farmakoepidemiologicheskogo issledovaniia arterial'noi gipertonii PIFAGOR IV: priverzhennost' vrachei. RMZh. 2015; 1 (117): 59–66. [in Russian]
4. Leonova M.V., Belousov D.Iu., Shteinberg L.L. i dr. Analiz vrachebnoi praktiki provedeniia antigipertenzivnoi terapii v Rossii (po dannym issledovaniia PIFAGOR III). Farmateka. 2009; 2: 98–103. [in Russian]
5. Chazova I.E., Zhernakova Iu.V., Oshchepkova E.V. i dr. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12. [in Russian]
6. Veterans Administration Cooperative Study on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. JAMA 1967; 202: 116–22.
7. SHEP Cooperative Research Study Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3255–64.
8. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium-channel blocker vs diuretic: The Antihypertensive an Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97.
9. Peterzan MA, Hardy R, Chaturvedi N, Hughes AD. Meta-analysis of dose-response relationships for hydrochlorothiazide, chlorthalidone, and bendroflumethiazide on blood pressure, serum potassium, and urate. Hypertension 2012; 59: 1104–9.
10. Psaty BM, Lumley T, Furberg CD et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003; 289: 2534–44.
11. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: Effects of various classes of antihypertensive drugs-overview and meta-analyses. J Hypertens 2015; 33 (2): 195–211.
12. Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982; 248: 1465–77.
13. Carter BL, Ernst ME, Cohen JD. Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension 2004; 43: 4–9.
14. Кurtz TW. Chlorthalidone: don’t call it “thiazide-like” anymore. Hypertension 2010; 56: 335–7.
15. Liebson PR, Grandits GA, Dianzumba S et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation 1995; 91 (3): 698–706.
16. Materson BJ, Oster JR, Michael UF et al. Dose response to chlorthalidone in patients with mild hypertension, efficacy of a lower dose. Clin Pharmacol Ther 1978; 24: 192–8.
17. Khosla N, Chua DY, Elliott WJ, Bakris GL. Are chlorthalidone and hydrochlorothiazide equivalent blood-pressure-lowering medications? J Clin Hypertens (Greenwich) 2005; 7 (6): 354–6.
18. Musini V, Nazer M, Bassett K et al. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev 2014; 5: CD003824; doi: 10.1002/14651858.CD003824.pub2.
19. Nedogoda S.V. Azilsartan: rasshirit li on vozmozhnosti lecheniia arterial'noĭ gipertenzii? Kardiologiia. 2015: 4: 97–100. [in Russian]
20. Bakris G, Sica D, White WB et al. Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil. Am J Med 2012; 125: 1229. e1–1229.e10.
21. Calhoun DA, Jones D, Textor S et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117: e510–e526.
2. 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). J Hypertens 2013; 31: 1281–357.
3. Леонова М.В., Штейнберг Л.Л., Белоусов Д.Ю. и др. Результаты фармакоэпидемиологического исследования артериальной гипертонии ПИФАГОР IV: приверженность врачей. РМЖ. 2015; 1 (117): 59–66. / Leonova M.V., Shteinberg L.L., Belousov D.Iu. i dr. Rezul'taty farmakoepidemiologicheskogo issledovaniia arterial'noi gipertonii PIFAGOR IV: priverzhennost' vrachei. RMZh. 2015; 1 (117): 59–66. [in Russian]
4. Леонова М.В., Белоусов Д.Ю., Штейнберг Л.Л. и др. Анализ врачебной практики проведения антигипертензивной терапии в России (по данным исследования ПИФАГОР III). Фарматека. 2009; 2: 98–103. / Leonova M.V., Belousov D.Iu., Shteinberg L.L. i dr. Analiz vrachebnoi praktiki provedeniia antigipertenzivnoi terapii v Rossii (po dannym issledovaniia PIFAGOR III). Farmateka. 2009; 2: 98–103. [in Russian]
5. Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014; 10: 4–12. / Chazova I.E., Zhernakova Iu.V., Oshchepkova E.V. i dr. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12. [in Russian]
6. Veterans Administration Cooperative Study on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. JAMA 1967; 202: 116–22.
7. SHEP Cooperative Research Study Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3255–64.
8. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium-channel blocker vs diuretic: The Antihypertensive an Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97.
9. Peterzan MA, Hardy R, Chaturvedi N, Hughes AD. Meta-analysis of dose-response relationships for hydrochlorothiazide, chlorthalidone, and bendroflumethiazide on blood pressure, serum potassium, and urate. Hypertension 2012; 59: 1104–9.
10. Psaty BM, Lumley T, Furberg CD et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003; 289: 2534–44.
11. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: Effects of various classes of antihypertensive drugs-overview and meta-analyses. J Hypertens 2015; 33 (2): 195–211.
12. Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982; 248: 1465–77.
13. Carter BL, Ernst ME, Cohen JD. Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension 2004; 43: 4–9.
14. Кurtz TW. Chlorthalidone: don’t call it “thiazide-like” anymore. Hypertension 2010; 56: 335–7.
15. Liebson PR, Grandits GA, Dianzumba S et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation 1995; 91 (3): 698–706.
16. Materson BJ, Oster JR, Michael UF et al. Dose response to chlorthalidone in patients with mild hypertension, efficacy of a lower dose. Clin Pharmacol Ther 1978; 24: 192–8.
17. Khosla N, Chua DY, Elliott WJ, Bakris GL. Are chlorthalidone and hydrochlorothiazide equivalent blood-pressure-lowering medications? J Clin Hypertens (Greenwich) 2005; 7 (6): 354–6.
18. Musini V, Nazer M, Bassett K et al. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev 2014; 5: CD003824; doi: 10.1002/14651858.CD003824.pub2.
19. Недогода С.В. Азилсартан: расширит ли он возможности лечения артериальной гипертензии? Кардиология. 2015: 4: 97–100. / Nedogoda S.V. Azilsartan: rasshirit li on vozmozhnosti lecheniia arterial'noĭ gipertenzii? Kardiologiia. 2015: 4: 97–100. [in Russian]
20. Bakris G, Sica D, White WB et al. Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil. Am J Med 2012; 125: 1229. e1–1229.e10.
21. Calhoun DA, Jones D, Textor S et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117: e510–e526.
________________________________________________
2. 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). J Hypertens 2013; 31: 1281–357.
3. Leonova M.V., Shteinberg L.L., Belousov D.Iu. i dr. Rezul'taty farmakoepidemiologicheskogo issledovaniia arterial'noi gipertonii PIFAGOR IV: priverzhennost' vrachei. RMZh. 2015; 1 (117): 59–66. [in Russian]
4. Leonova M.V., Belousov D.Iu., Shteinberg L.L. i dr. Analiz vrachebnoi praktiki provedeniia antigipertenzivnoi terapii v Rossii (po dannym issledovaniia PIFAGOR III). Farmateka. 2009; 2: 98–103. [in Russian]
5. Chazova I.E., Zhernakova Iu.V., Oshchepkova E.V. i dr. Rasprostranennost' faktorov riska serdechno-sosudistykh zabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014; 10: 4–12. [in Russian]
6. Veterans Administration Cooperative Study on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. JAMA 1967; 202: 116–22.
7. SHEP Cooperative Research Study Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3255–64.
8. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium-channel blocker vs diuretic: The Antihypertensive an Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97.
9. Peterzan MA, Hardy R, Chaturvedi N, Hughes AD. Meta-analysis of dose-response relationships for hydrochlorothiazide, chlorthalidone, and bendroflumethiazide on blood pressure, serum potassium, and urate. Hypertension 2012; 59: 1104–9.
10. Psaty BM, Lumley T, Furberg CD et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003; 289: 2534–44.
11. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: Effects of various classes of antihypertensive drugs-overview and meta-analyses. J Hypertens 2015; 33 (2): 195–211.
12. Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982; 248: 1465–77.
13. Carter BL, Ernst ME, Cohen JD. Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension 2004; 43: 4–9.
14. Кurtz TW. Chlorthalidone: don’t call it “thiazide-like” anymore. Hypertension 2010; 56: 335–7.
15. Liebson PR, Grandits GA, Dianzumba S et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation 1995; 91 (3): 698–706.
16. Materson BJ, Oster JR, Michael UF et al. Dose response to chlorthalidone in patients with mild hypertension, efficacy of a lower dose. Clin Pharmacol Ther 1978; 24: 192–8.
17. Khosla N, Chua DY, Elliott WJ, Bakris GL. Are chlorthalidone and hydrochlorothiazide equivalent blood-pressure-lowering medications? J Clin Hypertens (Greenwich) 2005; 7 (6): 354–6.
18. Musini V, Nazer M, Bassett K et al. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database Syst Rev 2014; 5: CD003824; doi: 10.1002/14651858.CD003824.pub2.
19. Nedogoda S.V. Azilsartan: rasshirit li on vozmozhnosti lecheniia arterial'noĭ gipertenzii? Kardiologiia. 2015: 4: 97–100. [in Russian]
20. Bakris G, Sica D, White WB et al. Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil. Am J Med 2012; 125: 1229. e1–1229.e10.
21. Calhoun DA, Jones D, Textor S et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117: e510–e526.
Авторы
И.Е.Чазова*, Т.В.Мартынюк
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*chazova@hotmail.com
A.L.Myasnikov Institute of Clinical Cardiology Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
*chazova@hotmail.com
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*chazova@hotmail.com
________________________________________________
A.L.Myasnikov Institute of Clinical Cardiology Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
*chazova@hotmail.com
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