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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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Chazova I.E., Martyniuk T.V. Diuretics in combination antihypertensive therapy: focus on forecast. Systemic Hypertension. 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.
Ключевые слова: артериальная гипертензия, диуретики, хлорталидон, гидрохлоротиазид, азилсартан, монотерапия, комбинированная терапия.
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In the modern therapy of arterial hypertension (AH) along with thiazide diuretics b-blockers, calcium antagonists, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are considered for initial and maintenance of antihypertensive therapy in the form of mono- or combination therapy. Five of these classes of drugs have comparable antihypertensive effectiveness and proven impact on prognosis in accordance with the results of randomized controlled clinical trials. The most widely used in clinical practice for the treatment of patients with AH received thiazide diuretics. The most powerful evidence base among the diuretics in regards to the effect on prognosis is сhlortalidone. The article presents data from a rando-mized, placebo-controlled and comparative studies сhlortalidone and hydrochlorothiazide in AH. It is shown that diuretics are the most effective component of combination therapy. The application of a new fixed combination сhlortalidone in combination with azilsartan medoxomil in our country will improve opportunities for effective treatment of this category of patients.
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. 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.
________________________________________________
1. Chazova I.E., Ratova L.G., Boitsov S.A., Nebieridze D.V. Diagnostika i lechenie arterial'noi gipertenzii (Rekomendatsii Rossiiskogo meditsinskogo obshchestva po arterial'noi gipertoniii Vserossiiskogo nauchnogo obshchestva kardiologov). Systemic Hypertension. 2010; 7 (3): 5–26. [in Russian]
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
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
________________________________________________
I.E.Chazova*, T.V.Martyniuk
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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