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Актуальные вопросы применения b-адреноблокаторов в клинической практике: все ли они одинаковы?
Актуальные вопросы применения b-адреноблокаторов в клинической практике: все ли они одинаковы?
Небиеридзе Д.В. Актуальные вопросы применения b-адреноблокаторов в клинической практике: все ли они одинаковы? Системные гипертензии. 2016; 13 (3): 21–24.
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Аннотация
В настоящем обзоре представлен современный взгляд на возможности b-адреноблокаторов (b-АБ) в разных клинических ситуациях. Класс b-АБ представляет неоднородную группу в плане возможностей клинического использования. Ряд b-АБ, особенно неселективных, обладают отрицательными эффектами и в некоторых клинических ситуациях не могут быть использованы (метаболические нарушения, хроническая обструктивная болезнь легких, периферический атеросклероз). Современные суперселективные b-АБ, к числу которых относится Беталок ЗОК, не обладают указанными отрицательными эффектами и могут широко использоваться в клинической практике, в том числе при метаболическом синдроме, сахарном диабете типа 2 и хронической обструктивной болезни легких. Другой проблемой, относящейся к b-АБ, является нечастое их назначение или использование в недостаточных дозах. В связи с этим практикующему врачу необходимо смелее назначать их в рекомендованных терапевтических дозах согласно инструкции по медицинскому применению лекарственного препарата в разных клинических ситуациях.
Ключевые слова: b-адреноблокаторы, метаболические эффекты, частота сердечных сокращений, Беталок ЗОК.
Key words: b-blockers, metabolic effects, heart rate, Betaloc ZOK.
Ключевые слова: b-адреноблокаторы, метаболические эффекты, частота сердечных сокращений, Беталок ЗОК.
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Key words: b-blockers, metabolic effects, heart rate, Betaloc ZOK.
Полный текст
Список литературы
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7. Berne C, Pollare T, Lithell H. Effects of antihypertensive treatment on insulin sensitivity with special reference to ACE inhibitors. Diabetes Care 1991, 14 (Suppl. 4): 39–47.
8. Lithell H. Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care 1991; 14: 203–9.
9. Reneland R, Alvares E, Andersson PL et al. Induction of insulin resistance by beta-blockade but not by ACE-inhibition: long-term treatment with atenolol or trandolapril. J Hum Hypertens 2000; 14: 175–80.
10. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Propranolol or HCTZ alone for the initial treatment of hypertension. IV. Effect on plasma glucose and glucose tolerance. Hypertension 1985; 7: 1008–16.
11. The Working Group on Hypertension in diabetes: Statement on hypertension in diabetes mellitus. Final report. Arch Int Med 1987; 147: 830–42.
12. Pool PE, Seagren SC, Salel AF: Metabolic consequences of treating hypertension. Am J Hypertens 1991; 4: 494–502.
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14. Pepine CJ, Handberg EM, Cooper-DeHoff RM et al. A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Tretment Strategy for Patients With Coronary Artery Disease The International Verapamil SR/Trandolapril Study (INVEST): A Randomized Controlled Trial. JAMA 2003; 290 (21): 2805–16.
15. The ALLHAT Officers and Coordinators Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288: 2981–97.
16. Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995–1003.
17. Beevers DG. The end of beta-bockers for uncomplicated hypertension? Lancet 2005; 366: 1510–2.
18. Kronig B. Hertz Kreislauf. J Clin Pharmacol 1990; 30: S28–S32. 28. 1990; 22: 224–9.
19. Falkner B, Kushner H. Treatment With Metoprolol Succinate, a Selective Beta Adrenergic Blocker, Lowers Blood Pressure Without Altering Insulin Sensitivity in Diabetic Patients. J Clin Hypertens 2008; 10: 51–7.
20. Gibbons RJ, Chatterjee K, Daley J et al. ACC/AHA/ACP-ASIM guidelines for themanagement of patientswith chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999; 33 (7): 2092–197.
21. Kolloch R, Legler UF, Champion A et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST). Eur Heart J 2008; 29: 1327–34.
22. Кобалава Ж.Д., Киякбаев Г.К., Хомицкая Ю.В., Шаваров А.А. Достижение целевого уровня частоты сердечных сокращений покоя у пациентов со стабильной стенокардией и артериальной гипертонией на фоне терапии b-адреноблокаторами в реальной клинической практике. Кардиология. 2013; 7: 1–11. / Kobalava Zh.D., Kiiakbaev G.K., Khomitskaia Iu.V., Shavarov A.A. Dostizhenie tselevogo urovnia chastoty serdechnykh sokrashchenii pokoia u patsientov so stabil'noi stenokardiei i arterial'noi gipertoniei na fone terapii b-adrenoblokatorami v real'noi klinicheskoi praktike. Kardiologiia. 2013; 7: 1–11. [in Russian]
23. Толпыгина С.Н., Марцевич С.Ю. Эффективность и безопасность высоких доз метопролола пролонгированного действия при лечении пациентов со стабильным течением ишемической болезни сердца. Рациональная фармакотерапия в кардиологии. 2008; 5: 46–52. / Tolpygina S.N., Martsevich S.Iu. Effektivnost' i bezopasnost' vysokikh doz metoprolola prolongirovannogo deistviia pri lechenii patsientov so stabil'nym techeniem ishemicheskoi bolezni serdtsa. Ratsional'naia farmakoterapiia v kardiologii. 2008; 5: 46–52. [in Russian]
24. The MERIT-HF investigators. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Interven tion Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7.
2. Diagnostika i lechenie khronicheskoi ishemicheskoi bolezni serdtsa. Klinicheskie rekomendatsii Minzdrava Rossii, 2013 g. RKNPK [Elektronnyi resurs], 10.12.2014. URL: http://www.cardioweb.ru/klinicheskie-rekomendatsii [in Russian]
3. Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN. Serdechnaia nedostatochnost'. 2013; 14 (7): 379–472. [in Russian]
4. Collins R, Peto R, MacMahon S et al. Blood pressure, stroke and coronary heart disease. Part II: Effects of short term-reductions of blood pressure – an overview of the unconfined randomized drug trials in an epidemiological context. Lancet 1990; 335: 827–38.
5. Kaplan M. Metabolic Aspects of Hypertension. London: Science press, 1994.
6. Viskin S, Kitzis I, Lev E et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. JACC 1995; 25: 1327–32.
7. Berne C, Pollare T, Lithell H. Effects of antihypertensive treatment on insulin sensitivity with special reference to ACE inhibitors. Diabetes Care 1991, 14 (Suppl. 4): 39–47.
8. Lithell H. Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care 1991; 14: 203–9.
9. Reneland R, Alvares E, Andersson PL et al. Induction of insulin resistance by beta-blockade but not by ACE-inhibition: long-term treatment with atenolol or trandolapril. J Hum Hypertens 2000; 14: 175–80.
10. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Propranolol or HCTZ alone for the initial treatment of hypertension. IV. Effect on plasma glucose and glucose tolerance. Hypertension 1985; 7: 1008–16.
11. The Working Group on Hypertension in diabetes: Statement on hypertension in diabetes mellitus. Final report. Arch Int Med 1987; 147: 830–42.
12. Pool PE, Seagren SC, Salel AF: Metabolic consequences of treating hypertension. Am J Hypertens 1991; 4: 494–502.
13. Weidmann P, Feffier C, Saxenhofer H et al. Serum lipoproteins during treatment with antihypertensive drugs. Drugs 1988; 35 (Suppl. 6): 118–34.
14. Pepine CJ, Handberg EM, Cooper-DeHoff RM et al. A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Tretment Strategy for Patients With Coronary Artery Disease The International Verapamil SR/Trandolapril Study (INVEST): A Randomized Controlled Trial. JAMA 2003; 290 (21): 2805–16.
15. The ALLHAT Officers and Coordinators Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288: 2981–97.
16. Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995–1003.
17. Beevers DG. The end of beta-bockers for uncomplicated hypertension? Lancet 2005; 366: 1510–2.
18. Kronig B. Hertz Kreislauf. J Clin Pharmacol 1990; 30: S28–S32. 28. 1990; 22: 224–9.
19. Falkner B, Kushner H. Treatment With Metoprolol Succinate, a Selective Beta Adrenergic Blocker, Lowers Blood Pressure Without Altering Insulin Sensitivity in Diabetic Patients. J Clin Hypertens 2008; 10: 51–7.
20. Gibbons RJ, Chatterjee K, Daley J et al. ACC/AHA/ACP-ASIM guidelines for themanagement of patientswith chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999; 33 (7): 2092–197.
21. Kolloch R, Legler UF, Champion A et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST). Eur Heart J 2008; 29: 1327–34.
22. Kobalava Zh.D., Kiiakbaev G.K., Khomitskaia Iu.V., Shavarov A.A. Dostizhenie tselevogo urovnia chastoty serdechnykh sokrashchenii pokoia u patsientov so stabil'noi stenokardiei i arterial'noi gipertoniei na fone terapii b-adrenoblokatorami v real'noi klinicheskoi praktike. Kardiologiia. 2013; 7: 1–11. [in Russian]
23. Tolpygina S.N., Martsevich S.Iu. Effektivnost' i bezopasnost' vysokikh doz metoprolola prolongirovannogo deistviia pri lechenii patsientov so stabil'nym techeniem ishemicheskoi bolezni serdtsa. Ratsional'naia farmakoterapiia v kardiologii. 2008; 5: 46–52. [in Russian]
24. The MERIT-HF investigators. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Interven tion Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7.
2. Диагностика и лечение хронической ишемической болезни сердца. Клинические рекомендации Минздрава России, 2013 г. РКНПК [Электронный ресурс], 10.12.2014. URL: http://www.cardioweb.ru/klinicheskie-rekomendatsii / Diagnostika i lechenie khronicheskoi ishemicheskoi bolezni serdtsa. Klinicheskie rekomendatsii Minzdrava Rossii, 2013 g. RKNPK [Elektronnyi resurs], 10.12.2014. URL: http://www.cardioweb.ru/klinicheskie-rekomendatsii [in Russian]
3. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН. Сердечная недостаточность. 2013; 14 (7): 379–472. / Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN. Serdechnaia nedostatochnost'. 2013; 14 (7): 379–472. [in Russian]
4. Collins R, Peto R, MacMahon S et al. Blood pressure, stroke and coronary heart disease. Part II: Effects of short term-reductions of blood pressure – an overview of the unconfined randomized drug trials in an epidemiological context. Lancet 1990; 335: 827–38.
5. Kaplan M. Metabolic Aspects of Hypertension. London: Science press, 1994.
6. Viskin S, Kitzis I, Lev E et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. JACC 1995; 25: 1327–32.
7. Berne C, Pollare T, Lithell H. Effects of antihypertensive treatment on insulin sensitivity with special reference to ACE inhibitors. Diabetes Care 1991, 14 (Suppl. 4): 39–47.
8. Lithell H. Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care 1991; 14: 203–9.
9. Reneland R, Alvares E, Andersson PL et al. Induction of insulin resistance by beta-blockade but not by ACE-inhibition: long-term treatment with atenolol or trandolapril. J Hum Hypertens 2000; 14: 175–80.
10. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Propranolol or HCTZ alone for the initial treatment of hypertension. IV. Effect on plasma glucose and glucose tolerance. Hypertension 1985; 7: 1008–16.
11. The Working Group on Hypertension in diabetes: Statement on hypertension in diabetes mellitus. Final report. Arch Int Med 1987; 147: 830–42.
12. Pool PE, Seagren SC, Salel AF: Metabolic consequences of treating hypertension. Am J Hypertens 1991; 4: 494–502.
13. Weidmann P, Feffier C, Saxenhofer H et al. Serum lipoproteins during treatment with antihypertensive drugs. Drugs 1988; 35 (Suppl. 6): 118–34.
14. Pepine CJ, Handberg EM, Cooper-DeHoff RM et al. A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Tretment Strategy for Patients With Coronary Artery Disease The International Verapamil SR/Trandolapril Study (INVEST): A Randomized Controlled Trial. JAMA 2003; 290 (21): 2805–16.
15. The ALLHAT Officers and Coordinators Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288: 2981–97.
16. Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995–1003.
17. Beevers DG. The end of beta-bockers for uncomplicated hypertension? Lancet 2005; 366: 1510–2.
18. Kronig B. Hertz Kreislauf. J Clin Pharmacol 1990; 30: S28–S32. 28. 1990; 22: 224–9.
19. Falkner B, Kushner H. Treatment With Metoprolol Succinate, a Selective Beta Adrenergic Blocker, Lowers Blood Pressure Without Altering Insulin Sensitivity in Diabetic Patients. J Clin Hypertens 2008; 10: 51–7.
20. Gibbons RJ, Chatterjee K, Daley J et al. ACC/AHA/ACP-ASIM guidelines for themanagement of patientswith chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999; 33 (7): 2092–197.
21. Kolloch R, Legler UF, Champion A et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST). Eur Heart J 2008; 29: 1327–34.
22. Кобалава Ж.Д., Киякбаев Г.К., Хомицкая Ю.В., Шаваров А.А. Достижение целевого уровня частоты сердечных сокращений покоя у пациентов со стабильной стенокардией и артериальной гипертонией на фоне терапии b-адреноблокаторами в реальной клинической практике. Кардиология. 2013; 7: 1–11. / Kobalava Zh.D., Kiiakbaev G.K., Khomitskaia Iu.V., Shavarov A.A. Dostizhenie tselevogo urovnia chastoty serdechnykh sokrashchenii pokoia u patsientov so stabil'noi stenokardiei i arterial'noi gipertoniei na fone terapii b-adrenoblokatorami v real'noi klinicheskoi praktike. Kardiologiia. 2013; 7: 1–11. [in Russian]
23. Толпыгина С.Н., Марцевич С.Ю. Эффективность и безопасность высоких доз метопролола пролонгированного действия при лечении пациентов со стабильным течением ишемической болезни сердца. Рациональная фармакотерапия в кардиологии. 2008; 5: 46–52. / Tolpygina S.N., Martsevich S.Iu. Effektivnost' i bezopasnost' vysokikh doz metoprolola prolongirovannogo deistviia pri lechenii patsientov so stabil'nym techeniem ishemicheskoi bolezni serdtsa. Ratsional'naia farmakoterapiia v kardiologii. 2008; 5: 46–52. [in Russian]
24. The MERIT-HF investigators. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Interven tion Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7.
________________________________________________
2. Diagnostika i lechenie khronicheskoi ishemicheskoi bolezni serdtsa. Klinicheskie rekomendatsii Minzdrava Rossii, 2013 g. RKNPK [Elektronnyi resurs], 10.12.2014. URL: http://www.cardioweb.ru/klinicheskie-rekomendatsii [in Russian]
3. Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN. Serdechnaia nedostatochnost'. 2013; 14 (7): 379–472. [in Russian]
4. Collins R, Peto R, MacMahon S et al. Blood pressure, stroke and coronary heart disease. Part II: Effects of short term-reductions of blood pressure – an overview of the unconfined randomized drug trials in an epidemiological context. Lancet 1990; 335: 827–38.
5. Kaplan M. Metabolic Aspects of Hypertension. London: Science press, 1994.
6. Viskin S, Kitzis I, Lev E et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. JACC 1995; 25: 1327–32.
7. Berne C, Pollare T, Lithell H. Effects of antihypertensive treatment on insulin sensitivity with special reference to ACE inhibitors. Diabetes Care 1991, 14 (Suppl. 4): 39–47.
8. Lithell H. Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care 1991; 14: 203–9.
9. Reneland R, Alvares E, Andersson PL et al. Induction of insulin resistance by beta-blockade but not by ACE-inhibition: long-term treatment with atenolol or trandolapril. J Hum Hypertens 2000; 14: 175–80.
10. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Propranolol or HCTZ alone for the initial treatment of hypertension. IV. Effect on plasma glucose and glucose tolerance. Hypertension 1985; 7: 1008–16.
11. The Working Group on Hypertension in diabetes: Statement on hypertension in diabetes mellitus. Final report. Arch Int Med 1987; 147: 830–42.
12. Pool PE, Seagren SC, Salel AF: Metabolic consequences of treating hypertension. Am J Hypertens 1991; 4: 494–502.
13. Weidmann P, Feffier C, Saxenhofer H et al. Serum lipoproteins during treatment with antihypertensive drugs. Drugs 1988; 35 (Suppl. 6): 118–34.
14. Pepine CJ, Handberg EM, Cooper-DeHoff RM et al. A Calcium Antagonist vs a Non-Calcium Antagonist Hypertension Tretment Strategy for Patients With Coronary Artery Disease The International Verapamil SR/Trandolapril Study (INVEST): A Randomized Controlled Trial. JAMA 2003; 290 (21): 2805–16.
15. The ALLHAT Officers and Coordinators Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288: 2981–97.
16. Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995–1003.
17. Beevers DG. The end of beta-bockers for uncomplicated hypertension? Lancet 2005; 366: 1510–2.
18. Kronig B. Hertz Kreislauf. J Clin Pharmacol 1990; 30: S28–S32. 28. 1990; 22: 224–9.
19. Falkner B, Kushner H. Treatment With Metoprolol Succinate, a Selective Beta Adrenergic Blocker, Lowers Blood Pressure Without Altering Insulin Sensitivity in Diabetic Patients. J Clin Hypertens 2008; 10: 51–7.
20. Gibbons RJ, Chatterjee K, Daley J et al. ACC/AHA/ACP-ASIM guidelines for themanagement of patientswith chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999; 33 (7): 2092–197.
21. Kolloch R, Legler UF, Champion A et al. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST). Eur Heart J 2008; 29: 1327–34.
22. Kobalava Zh.D., Kiiakbaev G.K., Khomitskaia Iu.V., Shavarov A.A. Dostizhenie tselevogo urovnia chastoty serdechnykh sokrashchenii pokoia u patsientov so stabil'noi stenokardiei i arterial'noi gipertoniei na fone terapii b-adrenoblokatorami v real'noi klinicheskoi praktike. Kardiologiia. 2013; 7: 1–11. [in Russian]
23. Tolpygina S.N., Martsevich S.Iu. Effektivnost' i bezopasnost' vysokikh doz metoprolola prolongirovannogo deistviia pri lechenii patsientov so stabil'nym techeniem ishemicheskoi bolezni serdtsa. Ratsional'naia farmakoterapiia v kardiologii. 2008; 5: 46–52. [in Russian]
24. The MERIT-HF investigators. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Interven tion Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001–7.
Авторы
Д.В.Небиеридзе
ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3
*DNeberidze@gnicpm.ru
State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101000, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3
*DNeberidze@gnicpm.ru
ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3
*DNeberidze@gnicpm.ru
________________________________________________
State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101000, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3
*DNeberidze@gnicpm.ru
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