В статье обсуждаются факторы, повышающие жесткость сосудистой стенки: уровень артериального давления, атеросклероз, курение, сахарный диабет, возраст. Приведены данные о том, что скорость пульсовой волны и ряд других показателей, которые отражают состояние сосудистой стенки, являются маркерами повышенного риска развития сердечно-сосудистых осложнений и смертности. Рассмотрено влияние антигипертензивных препаратов разных групп на жесткость сосудистой стенки, особое внимание уделено эффектам лекарственных средств из группы диуретиков. Обсуждаются возможные механизмы влияния индапамида ретард на эластические свойства сосудов. Подчеркивается, что влияние на жесткость артерий разных антигипертезивных медикаментов, даже относящихся к одному классу, отличается, что обусловлено различием в фармакокинетических свойствах.
The article discusses the factors that increase the arterial stiffness: the blood pressure, atherosclerosis, smoking, diabetes, age. Given evidence that pulse wave velocity and a number of other indicators that reflect the state of the vascular wall, are markers for increased risk of cardiovascular complications and mortality. The influence of antihypertensive drugs of different groups on the stiffness of the vascular wall, with particular attention paid to the effects of drugs from group of diuretics. We discuss possible mechanisms of the influence of indapamide retard on the elastic properties of vessels. It is emphasized that the influence on the stiffness of the arteries of different antigipertenzivny medicines, even belong to the same class, is different, due to differences in pharmacokinetic properties.
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1. Klinicheskie rekomendatsii. Diagnostika i lechenie arterial'noi gipertonii. Kardiologicheskii vestn. 2015; 1: 3–30. [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. Panza JA, Quyyumi AA, Brush JE et al. Abnormal endothelium-dependent vascular rela[ation in patients with essential hypertension. N Eng J Med 1990; 323 (5): 22–7.
4. Boutouyne P, Laurent S, Girerd X et al. Common carotid artery stiffness and patterns of left ventricular hypertrophy in hypertensive patients. Hypertension 1995; 25 (4 Pt 1): 651–6.
5. London GM. Cardiovascular disease in chronic renal failure: pathophysiologic aspects. Semin Dial 2003; 16 (2): 85–94.
6. Safar ME, London GM. The arterial system in human hypertension. In Textbook of Hypertension. Ed. J.D.Swales. London: Blackwell Scientific, 1994; р. 85–102.
7. Watanabe H, Obtsuka S, Kakibana M et al. Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Col Cardiol 1993; 21 (6): 1497–506.
8. Chang КС, Tseng YZ, Kuo TS et al. Impaired left ventricular relaxation and arterial stiffness in patients with essential hypertension. Clinical Sci 1994; 87 (6): 641–7.
9. Posadzy-Malaczynska A, Kosch M, Hausberg M et al. Arterial distensibility, intima media thickness and pulse wave velocity after renal transplantation and in dialysis normotensive patients. Int Angiol 2005; 24 (1): 89–94.
10. Asmar R, Rudnichi A, Blacher I et al. Pulse pressure and aortic pulse wave are markers of cardiovascular risk in hypertensive populations. Am J Hypertens 2001; 14 (2): 91–7.
11. Laurent S, Boutouyrie P, Asmar R et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37: 1236–41.
12. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55: 1318–27.
13. Вlacher J, Asmar R, Djane S. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 2001; 33: 1111–17.
14. Miliagin V.A., Komissarov V.B. Sovremennye metody opredeleniia zhestkosti sosudov. Arterial'naia gipertenziia. 2010; 16 (2): 134–43. [in Russian]
15. Finkelstein SM, Collins VR, Cohn JN. Vascular compliance response to vasodilators by Fourier and pulse contour analysis. Hypertension 1988; 12: 380–7.
16. Pannier B, Avolio AP, Hoeks A et al. Methods and devices for measuring arterial compliance in humans. Am J Hypertens 2002; 15: 743–53.
17. Dart AM, Gatzka CD, Kingwell BA et al. Brachial blood pressure but not carotid arterial waveforms predict cardiovascular events in elderly female hypertensives. Hypertension 2006; 47: 785–90.
18. Hoeks AP, Brands PJ, Smeets FA, Reneman RS. Assessment of the distensibility of superficial arteries. Ultrasound Med Biol 1990; 16: 121–8.
19. Laurent S, Caviezel B, Beck L et al. Carotid artery distensibility and distending pressure in hypertensive humans. Hypertension 1994; 23: 878–83.
20. Meinders JM, Kornet L, Brands PJ, Hoeks AP. Assessment of local pulse wave velocity in arteries using 2D distension waveforms. Ultrason Imageing 2001; 23: 199–215.
21. Martynov A.I., Ternovoi S.K., Ostroumova O.D. i dr. Osobennosti izmeneniia rastiazhimosti aorty u pozhilykh bol'nykh na fone dlitel'noi terapii razlichnymi klassami gipotenzivnykh sredstv (po dannym magnitno-rezonansnoi tomografii. Kardiologiia. 2002; 5: 19–22. [in Russian]
22. Asmar R. Arterial stiffness and pulse wave velocity. Clinical applications. Paris: Elsevier, 1999.
23. Boutouyrie P, Pannier B. Measurement of arterial stiffness. In: Laurent S, Cockroft J. Central aortic blood pressure. 2008; p. 41–7.
24. Lacolley P, Regnault V. Basic principles and molecular determinants of arterial stiffness. In: Laurent S, Cockroft J. Central aortic blood pressure. 2008; p. 27–34.
25. Laurent S, Cockcroft J, van Bortel L et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 2588–605.
26. Latham RD, Westerhof N, Sipkema P et al. Regional wave travel and reflections along the human aorta: a study with six simultaneous micromanometric pressures. Circulation 1985; 72: 1257–69.
27. Avolio AP, Deng FQ, Li WQ et al. Effects of agingon arterial distensibility in populations with high and low prevalense of hypertension: Comparison between urban and rural communities in China. Circulation 1985; 71: 202–10.
28. Filipovsky J. Predictive value of central blood pressure and arterial stiffness for cardiovascular events. In: Laurent S, Cockroft J. Central aortic blood pressure. 2008; p. 61–7.
29. Mancia G, De Backer G, Dominiczak A et al. 2007 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 2007; 25: 1105–87.
30. Van Bortel LM, Laurent S, Boutouyrie P et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 2012; 30: 445–8.
31. Rebrov A.P. Zhestkost' arterii v zavisimosti ot nalichiia faktorov riska razvitiia serdechno-sosudistykh zabolevanii. Terapevt. arkh. 2009; 81 (3): 54–7. [in Russian]
32. Orlova Ia.A. Zhestkost' arterii, kak prediktor serdechno-sosudistykh oslozhnenii pri IBS. Terapevt. arkh. 2010: 82 (1): 68–73. [in Russian]
33. Mathiassen ON, Buus NH, Sihm I. Small artery structure is an independent predictor of cardiovascular events in essential hypertension. J Hypertens 2007; 25: 1021–6.
34. Boitsov S.A. Chto novogo nam daet informatsiia o zhestkosti stenki arterii i ob otrazhennoi pul'sovoi volne? Ros. fiziol. zhurn. im. I.M.Sechenova. 2009; 95 (5): 516–31. [in Russian]
35. Tomiyama H, Yamashina A, Arai T et al. Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement – a survey of 12517 subjects. Atherosclerosis 2003; 166 (2): 303–9.
36. Ohmori K, Emura S, Takashima T. Risk factors of atherosclerosis and aortic pulse wave velocity. Angiology 2000; 51 (1): 53–60.
37. Schram MT, Henry RM, van Dijk RA et al. Increased central arterial stiffness in impaired glucose metabolism and type 2 diabetes: the Hoorn study. Hypertension 2005; 43: 176–81.
38. Schram MT, Schalwijk CG, Bootsma AH et al. Advanced glycation end products are associated with pulse pressure in type 1 diabetes: the EURODIAB Prospective Complications Study. Hypertension 2005; 46: 232–7.
39. Mahmud A, Feely J. Reduction in arterial stiffness with angiotensin II antagonist is comparable with and additive to ACE inhibition. Am J Hypertens 2002; 15: 321–5.
40. Levenson J, Simon AC, Cambien FA, Beretti C. Cigarettes smoking and hypertension. Factors independently associated with blood hyperviscosity and arterial rigidity. Arteriosclerosis 1987; 7: 572–8.
41. Wilkinson IB, Prasad K, Hall IR et al. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol 2002; 39: 1005–11.
42. Van Popele NM, Grobbee DE, Bots M et al. Association Between Arterial Stiffness and Atherosclerosis. Stroke 2001; 32: 454–60.
43. Bortolotto LA, Safar ME, Billaud E et al. Plasma homocysteine, aortic stiffness, and renal function in hypertensive patients. Hypertension 1999; 34: 837–42.
44. Booth AD, Wallace S, McEniery CM et al. Inflammation and arterial stiffness in systematic vasculites: a model of vascular inflammation. Arthritis Rheum 2004; 50: 581–857.
45. Yasmin, McEniery CM, Wallace S. C-reactive protein is associated with arterial stiffness in apparently healthy individuals. Arteriocler Thromb Vasc Biol 2004; 24: 969–74.
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Авторы
О.Д.Остроумова*1,2, А.И.Кочетков1, М.В.Лопухина3
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;
3 ГБУЗ Городская клиническая больница им. Е.О.Мухина Департамента здравоохранения Москвы. 111399, Россия, Москва, Федеративный просп., д. 17
*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, ul. Delegatskaia, d. 20, str. 1;
2 I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaya, d. 8, str. 2;
3 E.O.Mukhin City Clinical Hospital of the Department of Health of Moscow. 111399, Russian Federation, Moscow, Federativnyi prosp., d. 17
*ostroumova.olga@mail.ru