Преимущества азилсартана медоксомила у пациентов с артериальной гипертонией: как правильно осуществить выбор и оптимизировать антигипертензивную терапию?

Преимущества азилсартана медоксомила у пациентов с артериальной гипертонией: как правильно осуществить выбор и оптимизировать антигипертензивную терапию?

Мартынюк Т.В., Чазова И.Е. Преимущества азилсартана медоксомила у пациентов с артериальной гипертонией: как правильно осуществить выбор и оптимизировать антигипертензивную терапию? Системные гипертензии. 2017; 14 (2): 45–50. DOI: 10.26442/2075-082X_14.2.45-50

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Martynyuk T.V., Chazova I.E. Advantages azilsartan medoxomil in patients with arterial hypertension: how to make a choice and to optimize antihypertensive therapy? Systemic Hypertension. 2017; 14 (2): 45–50. DOI: 10.26442/2075-082X_14.2.45-50

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Аннотация

Азилсартана медоксомил – препарат из класса блокаторов рецепторов ангиотензина (сартанов), обладающий выраженным антигипертензивным эффектом и безупречным профилем переносимости. По сравнению с другими препаратами (кандесартан, олмесартан, рамиприл, хлорталидон, валсартан) по данным сравнительных исследований и метаанализов азилсартана медоксомил демонстрирует высокую антигипертензивную эффективность с точки зрения 24-часового контроля артериального давления (АД), что позволяет рекомендовать его назначение у пациентов с артериальной гипертонией 1–2-й степени. Это связано со способностью препарата не только надежно снижать АД в дневные и ночные часы, но и нормализовать суточный профиль. Плейотропные эффекты азилсартана медоксомила в виде повышения чувствительности рецепторов к инсулину, положительного влияния на метаболизм глюкозы, улучшения функции эндотелия позволяют рассматривать его назначение у пациентов с нарушениями углеводного обмена, избыточной массой тела, ожирением, метаболическим синдромом. Препарат показан как пациентам, ранее не получавшим антигипертензивную терапию, так и в том случае, если предшествующее лечение другими блокаторами ренин-ангиотензин-альдостероновой системы не приводило к надежному достижению целевого уровня АД. Высокая эффективность и благоприятный профиль безопасности азилсартана медоксомила могут обеспечить лучшую приверженность пациентов долгосрочной терапии и достижение оптимальных результатов лечения.

Ключевые слова: артериальная гипертония, азилсартана медоксомил, блокаторы рецепторов ангиотензина II, суточное мониторирование артериального давления, нон-дипперы, найт-пикеры.

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Azilsartan medoxomil is a drug from class of angiotensin II receptor antagonist (sartans), have a antihypertensive effect and excellent tolerability profile. In comparison with other drugs (candesartan, olmesartan, ramipril, chlorthalidone, valsartan) according to comparative studies and meta-analyses azilsartan medoxomil demonstrated high antihypertensive efficacy, in terms of 24-hour BP control, which allows to recommend its purpose in patients of hypertension 1–2 degrees. This is due to the ability of the drug not only safely reduce AD during day and night hours, but also to normalize the circadian profile. Pleiotropic effects of azilsartan medoxomil in the form of increased sensitivity of receptors to insulin, a positive effect on glucose metabolism, improved endothelial function allow us to consider its purpose in patients with carbohydrate metabolism disorders, overweight, obesity, and metabolic syndrome. The drug is indicated for as patients who have not previously received antihypertensive therapy and if previous treatment with other RAAS blockers did not lead to reliable achievement of target BP levels. High efficiency and safety of azilsartan medoxomil can provide better patient adherence to long term therapy and achieve optimal results of therapy.

Key words: arterial hypertension, azilsartan medoxomil, angiotensin II receptor antagonist, daily monitoring of blood pressure, non-dippers, night-peaker.

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Список литературы

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22. Sica D, Bakris GL, White WB et al. Blood pressure-lowering efficacy of the fixed-dose combination of azilsartanmedoxomil and chlorthalidone: a factorial study. J Clin Hypertens (Greenwich) 2012; 14: 284–92.
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25. Zhao M, Li Y, Wang J et al. Azilsartan treatment improves insulin sensitivity in obese spontaneously hypertensive Koletsky rats. Diabetes Obes Metab 2011; 13: 1123–9.
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1. 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 Hypertension 2013; 31 (7): 1281–357.
2. Collins R, Peto R, MacMahon S et al. Blood pressure, stroke, and coronary heart disease: part 2, short-term reductions in blood pressure. Lancet 1990; 335 (8693): 827–38.
3. Forouzanfar MH, Liu P, Roth GA et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mmHg, 1990–2015. JAMA 2017; 317 (2): 165–82.
4. Diagnostika i lechenie arterial'noi gipertonii. Klinicheskie rekomendatsii 2013 g. http://webmed.irkutsk.ru/doc/pdf/fedhypert.pdf [in Russian]
5. 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]
6. 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]
7. Perry CM. Azilsartan medoxomil: a review of its use in hypertension. Clin Drug Investig 2012; 32: 621–39.
8. Baker WL, White WB. Azilsartan medoxomil: a new angiotensin II receptor antagonist for treatment of hypertension. Ann Pharmacother 2011; 45: 1506–15.
9. Ojima M, Igata H, Tanaka M et al. In vitro antagonistic properties of a new angiotensin type 1 receptor blocker, azilsartan, in receptor binding and function studies. J Pharmacol Exp Ther 2011; 336: 801–8.
10. Sica D, White WB, Weber MA et al. Comparison of the novel angiotensin II receptor blocker azilsartanmedoxomil vs. valsartan by ambulatory blood pressure monitoring. J Clin Hypertens (Greenwich) 2011; 13: 467–72.
11. Bönner G, Bakris GL, Sica D et al. Antihypertensive efficacy of the angiotensin receptor blocker azilsartanmedoxomil compared with the angiotensin-converting enzyme inhibitor ramipril. J Hum Hypertens 2013; 27: 479–86.
12. Rakugi H, Enya K, Sugiura K, Ikeda Y. Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double-blind clinical study. Hypertens Res 2012; 35: 552–8.
13. Chobanian AV, Bakris GL, Black HR et al. National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–52.
14. Dolan E, Stanton AV, Thom S et al. ASCOT Investigators. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients–an Anglo-Scandinavian cardiac outcomes trial substudy. J Hypertens 2009; 27: 876–85.
15. Ostroumova O.D., Kopchenov I.I., Shchukina G.N. Circadian rhythm of blood pressure: prognostic significance and possibility to correct it during the treatment using azilsartan medoxomil. Consilium Medicum. 2015; 17 (5): 8–13. [in Russian]
16. Cuspidi C, Michev I, Meani S et al. Reduced nocturnal fall in blood pressure, assessed by two ambulatory blood pressure monitorings and cardiac alterations in early phases of untreated essential hypertension. J Human Hypertens 2003; 17: 245–51.
17. Pierdomenico S, Bucci A, Costantini F et al. Circadian blood pressure changes and myocardial ischemia in hypertensive patients with coronary artery disease. J Am Coll Cardiol 1998; 31 (7): 1627–34.
18. Timio M, Venanzi S, Lolli S et al."Non-dipper" hypertensive patients and progressive renal insufficiency: a 3-year longitudinal study. Clin Nephrol 1995; 43 (6): 382–7.
19. Bakris GL, Sica D, Weber M et al. The comparative effects of azilsartan medoxomil and olmesartan on ambulatory and clinic blood pressure.J Clin Hypertens (Greenwich) 2011; 13: 81–8.
20. White WB, Weber MA, Sica D et al. Effects of the angiotensin receptor blocker azilsartanmedoxomil versus olmesartan and valsartan on ambulatory and clinic blood pressure in patients with stages 1 and 2 hypertension. Hypertension 2011; 57: 413–20.
21. Takagi H, Mizuno Y, Niwa M et al. A meta-analysis of randomized controlled trials of azilsartan therapy for blood pressure reduction. Hypertension Res 2014; 37: 432–7.
22. Sica D, Bakris GL, White WB et al. Blood pressure-lowering efficacy of the fixed-dose combination of azilsartanmedoxomil and chlorthalidone: a factorial study. J Clin Hypertens (Greenwich) 2012; 14: 284–92.
23. French CJ, Zaman AK, Sobel BE. The angiotensin receptor blocker, azilsartan medoxomil (TAK-491), suppresses vascular wall expression of plasminogen activator inhibitor type-I protein potentially facilitating the stabilization of atherosclerotic plaques. J Cardiovasc Pharmacol 2011; 58: 143–8.
24. Kajiya T, Ho C, Wang J et al. Molecular and cellular effects of azilsartan: a new generation angiotensin II receptor blocker. J Hypertens 2011; 29: 2476–83.
25. Zhao M, Li Y, Wang J et al. Azilsartan treatment improves insulin sensitivity in obese spontaneously hypertensive Koletsky rats. Diabetes Obes Metab 2011; 13: 1123–9.
26. He H, Yang D, Ma L et al. Telmisartan prevents weight gain and obesity through activation of peroxisome proliferator- activated receptor-delta-dependent pathways. Hypertension 2010; 55: 869–79.

Авторы

Т.В.Мартынюк*, И.Е.Чазова

Институт клинической кардиологии им. А.Л.Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*trukhiniv@mail.ru

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T.V.Martynyuk*, I.E.Chazova

National Medical Research Center for Cardiology of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
*trukhiniv@mail.ru

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