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Сохранение когнитивных функций у пациентов пожилого возраста: важность гериатрического подхода
Сохранение когнитивных функций у пациентов пожилого возраста: важность гериатрического подхода
Котовская Ю.В., Остапенко В.С., Ткачева О.Н. Сохранение когнитивных функций у пациентов пожилого возраста: важность гериатрического подхода. Справочник поликлинического врача. 2017; 5: 15–19.
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Аннотация
Проблема деменции имеет важное медицинское, социальное и экономическое значение в связи со старением популяции. Существует ряд шкал, позволяющих проводить скрининг когнитивных нарушений. Для клинической практики представляет интерес потенциальное влияние лекарственных препаратов на функционирование головного мозга, которые могут как выступать в роли факторов риска когнитивного снижения, так и иметь церебропротективное значение. В статье приведены данные об эффекте антагонистов кальция и М-холинолитиков, в частности нитрендипина и троспия хлорида, в отношении состояния когнитивных функций у пожилых пациентов.
Ключевые слова: когнитивные нарушения, деменция, артериальная гипертония, недержание мочи, нитрендипин, троспия хлорид.
Key words: cognitive impairment, dementia, arterial hypertension, urinary incontinence, nitrendipine, trospium chloride.
Ключевые слова: когнитивные нарушения, деменция, артериальная гипертония, недержание мочи, нитрендипин, троспия хлорид.
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Key words: cognitive impairment, dementia, arterial hypertension, urinary incontinence, nitrendipine, trospium chloride.
Полный текст
Список литературы
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2. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (9): 2672–713.
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24. Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50 (6): 1306–14.
25. Byles J et al. Living with urinary incontinence: a longitudinal study of older women. Age Ageing 2009; 38: 333.
26. Griffiths DJ, McCracken PN, Harrison GM et al. Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn 2002; 21: 126–31.
27. Zinner N, Gittelman M, Harris R et al. Trospium chloride improves overactive bladder symptoms: a multicenter phase III trial. J Urol 2004; 171 (6 Pt 1): 2311–5.
28. Cardozo L, Chappie CR, Toozs-Hobson P et al. Efficacy of trospium chloride in patients with detrusor instability: a placebo-controlled, randomized, double-blind, multicentre clinical trial. BJU Int 2000; 85 (6): 659–64.
29. Ulshofer B, Bihr A-M, Bodeker R-H et al. Randomised, double-blind, placebo-controlled study on the efficacy and tolerance of trospium chloride in patients with motor urge incontinence. Clin Drug Invest 2003; 21 (8): 563–9.
30. Madersbacher H, Stohrer M, Richter R et al. Trospium chloride versus oxybutynin: a randomized, double-blind, multicentre trial in the treatment of detrusor hyper-reflexia. Br J Urol 1995; 75 (4): 452–6.
31. Halaska M, Ralph G, Wiedemann A et al. Controlled, double-blind, multicentre clinical trial to investigate long-term tolera-bility and efficacy of trospium chloride in patients with detrusor instability. World J Urol 2003; 20 (6): 392–9.
32. Junemann KP, Al-Shukri S. Efficacy and tolerability of trospium chloride and tolterodine in 234 patients with urge syndrome: a double-blind, placebo-controlled, multicentre, clinical trial [abstract]. Neurourol Urodyn 2000; 19 (4): 488–90.
33. Notz HJ, Hautumm B et al. Trospium chloride once daily for overactive bladder syndrome: results of a multicenter observational study. Urologe A 2013; 52 (1): 65–70.
34. Staskin D, Kay G, Tannenbaum C et al. Trospium chloride has no effect on memory testing and is assay undetectable in the central nervous system of older patients with overactive bladder. Int J Clin Pract 2010; 64 (9): 1294–300.
35. Geller EJ, Dumond JB, Bowling JM et al. Effect of Trospium Chloride on Cognitive Function in Women Aged 50 and Older: A Randomized Trial. Female Pelvic Med Reconstr Surg 2017; 23 (2): 118–23.
36. Isik AT, Celik T et al. Trospium and cognition in patients with late onset Alzheimer disease. J Nutr Health Aging 2009; 13 (8): 672–6.
37. Araklitis G, Thiagamoorthy G, Hunter J et al. Anticholinergic prescription: are healthcare professionals the real burden? Int Urogynecol J 2017; 28 (8): 1249–56.
2. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (9): 2672–713.
3. Bosch J, Lonn E, Yusuf S; HOPE-3 Investigators. The effect of blood pressure and cholesterol lowering on cognition. Program and abstracts of the American Heart Association 2016 Scientific Sessions; November 13, 2016; New Orleans, Louisiana. Abstract LBCT-01.
4. Staessen JA, Thijs L, Richart T et al. Placebo-controlled trials of blood pressure-lowering therapies for primary prevention of dementia. Hypertension 2011; 57: e6–7.
5. Chang-Quan H, Hui W, Chao-Min W et al. The association of antihypertensive medication use with risk of cognitive decline and dementia: a meta-analysis of longitudinal studies. Int J Clin Pract 2011; 65 (12): 1295–305.
6. Petrella RJ, Shlyakhto E, Konradi AO et al. Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of theObservational Study on Cognitive Function and SBP Reduction (OSCAR) study. J Clin Hypertens (Greenwich) 2012; 14 (2): 78–84.
7. Kume K, Hanyu H, Sakurai H et al. Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer’s disease. Geriatr Gerontol Int 2012; 12 (2): 207–14.
8. Chiu WC, Ho WC, Lin MH et al. Angiotensin receptor blockers reduce the risk of dementia. J Hypertens 2014; 32: 938–47.
9. Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2012; 75 (1): 79–92.
10. Pase MP, Beiser A, Himali JJ et al. Aortic Stiffness and the Risk of Incident Mild Cognitive Impairment and Dementia. Stroke 2016; 47: 2256–61.
11. Mattace-Raso F, van der Cammen TJM, Hofman A et al. Arterial Stiffness and Risk of Coronary Heart Disease and Stroke. The Rotterdam Study. Circulation 2006; 113: 657–63.
12. Toescu EC, Xiong J. Metabolic substrates of neuronal aging. Ann N Y Acad Sci 2004; 1019: 19–23.
13. Bachmeier C, Beaulieu-Abdelahad D, Mullan M, Paris D. Selective dihydropyiridine compounds facilitate the clearance of beta-amyloid across the blood–brain barrier. Eur J Pharmacol 2011; 659: 124–9.
14. Paris D, Bachmeier C, Patel N et al. Selective antihypertensive dihydropyridines lower Ab accumulation by targeting both the production and the clearance of Ab across the blood-brain barrier. Mol Med 2011; 17: 149–62.
15. Corbett A, Pickett J, Burns A et al. Drug repositioning for Alzheimer’s disease. Nature Reviews Drug Discovery 2012; 11: 833–46.
16. Watfa G, Rossignol P, Kearney-Schwartz A et al. Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints. J Hypertens 2010; 28 (12): 2485–93.
17. Trompet S et al. Use of calcium antagonists and cognitive decline in old age. The Leiden 85-plus study. Neurobiol Aging 2008; 29 (2): 306–8.
18. Staessen JA, Fagard R, Thijs L. et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
19. Thijs L, Staessen JA, Beleva S et al. How well can blood pressure be controlled? Progress report on the Systolic Hypertension in Europe Follow-Up Study (Syst-Eur 2). Curr Control Trials Cardiovasc Med 2001; 2: 298–306.
20. Tuomilehto J et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
21. Liu L, Wang JG, Gong L et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertension 1998; 16: 1823–9.
22. Forette F, Seux ML, Staessen JA et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352 (9137): 1347–51.
23. Abrams P, Cardozo L, Fall M et al. Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisationsub-committee of the Internation al Continence Society. Urology 2003; 61 (1): 37–49.
24. Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50 (6): 1306–14.
25. Byles J et al. Living with urinary incontinence: a longitudinal study of older women. Age Ageing 2009; 38: 333.
26. Griffiths DJ, McCracken PN, Harrison GM et al. Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn 2002; 21: 126–31.
27. Zinner N, Gittelman M, Harris R et al. Trospium chloride improves overactive bladder symptoms: a multicenter phase III trial. J Urol 2004; 171 (6 Pt 1): 2311–5.
28. Cardozo L, Chappie CR, Toozs-Hobson P et al. Efficacy of trospium chloride in patients with detrusor instability: a placebo-controlled, randomized, double-blind, multicentre clinical trial. BJU Int 2000; 85 (6): 659–64.
29. Ulshofer B, Bihr A-M, Bodeker R-H et al. Randomised, double-blind, placebo-controlled study on the efficacy and tolerance of trospium chloride in patients with motor urge incontinence. Clin Drug Invest 2003; 21 (8): 563–9.
30. Madersbacher H, Stohrer M, Richter R et al. Trospium chloride versus oxybutynin: a randomized, double-blind, multicentre trial in the treatment of detrusor hyper-reflexia. Br J Urol 1995; 75 (4): 452–6.
31. Halaska M, Ralph G, Wiedemann A et al. Controlled, double-blind, multicentre clinical trial to investigate long-term tolera-bility and efficacy of trospium chloride in patients with detrusor instability. World J Urol 2003; 20 (6): 392–9.
32. Junemann KP, Al-Shukri S. Efficacy and tolerability of trospium chloride and tolterodine in 234 patients with urge syndrome: a double-blind, placebo-controlled, multicentre, clinical trial [abstract]. Neurourol Urodyn 2000; 19 (4): 488–90.
33. Notz HJ, Hautumm B et al. Trospium chloride once daily for overactive bladder syndrome: results of a multicenter observational study. Urologe A 2013; 52 (1): 65–70.
34. Staskin D, Kay G, Tannenbaum C et al. Trospium chloride has no effect on memory testing and is assay undetectable in the central nervous system of older patients with overactive bladder. Int J Clin Pract 2010; 64 (9): 1294–300.
35. Geller EJ, Dumond JB, Bowling JM et al. Effect of Trospium Chloride on Cognitive Function in Women Aged 50 and Older: A Randomized Trial. Female Pelvic Med Reconstr Surg 2017; 23 (2): 118–23.
36. Isik AT, Celik T et al. Trospium and cognition in patients with late onset Alzheimer disease. J Nutr Health Aging 2009; 13 (8): 672–6.
37. Araklitis G, Thiagamoorthy G, Hunter J et al. Anticholinergic prescription: are healthcare professionals the real burden? Int Urogynecol J 2017; 28 (8): 1249–56.
2. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (9): 2672–713.
3. Bosch J, Lonn E, Yusuf S; HOPE-3 Investigators. The effect of blood pressure and cholesterol lowering on cognition. Program and abstracts of the American Heart Association 2016 Scientific Sessions; November 13, 2016; New Orleans, Louisiana. Abstract LBCT-01.
4. Staessen JA, Thijs L, Richart T et al. Placebo-controlled trials of blood pressure-lowering therapies for primary prevention of dementia. Hypertension 2011; 57: e6–7.
5. Chang-Quan H, Hui W, Chao-Min W et al. The association of antihypertensive medication use with risk of cognitive decline and dementia: a meta-analysis of longitudinal studies. Int J Clin Pract 2011; 65 (12): 1295–305.
6. Petrella RJ, Shlyakhto E, Konradi AO et al. Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of theObservational Study on Cognitive Function and SBP Reduction (OSCAR) study. J Clin Hypertens (Greenwich) 2012; 14 (2): 78–84.
7. Kume K, Hanyu H, Sakurai H et al. Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer’s disease. Geriatr Gerontol Int 2012; 12 (2): 207–14.
8. Chiu WC, Ho WC, Lin MH et al. Angiotensin receptor blockers reduce the risk of dementia. J Hypertens 2014; 32: 938–47.
9. Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2012; 75 (1): 79–92.
10. Pase MP, Beiser A, Himali JJ et al. Aortic Stiffness and the Risk of Incident Mild Cognitive Impairment and Dementia. Stroke 2016; 47: 2256–61.
11. Mattace-Raso F, van der Cammen TJM, Hofman A et al. Arterial Stiffness and Risk of Coronary Heart Disease and Stroke. The Rotterdam Study. Circulation 2006; 113: 657–63.
12. Toescu EC, Xiong J. Metabolic substrates of neuronal aging. Ann N Y Acad Sci 2004; 1019: 19–23.
13. Bachmeier C, Beaulieu-Abdelahad D, Mullan M, Paris D. Selective dihydropyiridine compounds facilitate the clearance of beta-amyloid across the blood–brain barrier. Eur J Pharmacol 2011; 659: 124–9.
14. Paris D, Bachmeier C, Patel N et al. Selective antihypertensive dihydropyridines lower Ab accumulation by targeting both the production and the clearance of Ab across the blood-brain barrier. Mol Med 2011; 17: 149–62.
15. Corbett A, Pickett J, Burns A et al. Drug repositioning for Alzheimer’s disease. Nature Reviews Drug Discovery 2012; 11: 833–46.
16. Watfa G, Rossignol P, Kearney-Schwartz A et al. Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints. J Hypertens 2010; 28 (12): 2485–93.
17. Trompet S et al. Use of calcium antagonists and cognitive decline in old age. The Leiden 85-plus study. Neurobiol Aging 2008; 29 (2): 306–8.
18. Staessen JA, Fagard R, Thijs L. et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
19. Thijs L, Staessen JA, Beleva S et al. How well can blood pressure be controlled? Progress report on the Systolic Hypertension in Europe Follow-Up Study (Syst-Eur 2). Curr Control Trials Cardiovasc Med 2001; 2: 298–306.
20. Tuomilehto J et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
21. Liu L, Wang JG, Gong L et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertension 1998; 16: 1823–9.
22. Forette F, Seux ML, Staessen JA et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352 (9137): 1347–51.
23. Abrams P, Cardozo L, Fall M et al. Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisationsub-committee of the Internation al Continence Society. Urology 2003; 61 (1): 37–49.
24. Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50 (6): 1306–14.
25. Byles J et al. Living with urinary incontinence: a longitudinal study of older women. Age Ageing 2009; 38: 333.
26. Griffiths DJ, McCracken PN, Harrison GM et al. Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn 2002; 21: 126–31.
27. Zinner N, Gittelman M, Harris R et al. Trospium chloride improves overactive bladder symptoms: a multicenter phase III trial. J Urol 2004; 171 (6 Pt 1): 2311–5.
28. Cardozo L, Chappie CR, Toozs-Hobson P et al. Efficacy of trospium chloride in patients with detrusor instability: a placebo-controlled, randomized, double-blind, multicentre clinical trial. BJU Int 2000; 85 (6): 659–64.
29. Ulshofer B, Bihr A-M, Bodeker R-H et al. Randomised, double-blind, placebo-controlled study on the efficacy and tolerance of trospium chloride in patients with motor urge incontinence. Clin Drug Invest 2003; 21 (8): 563–9.
30. Madersbacher H, Stohrer M, Richter R et al. Trospium chloride versus oxybutynin: a randomized, double-blind, multicentre trial in the treatment of detrusor hyper-reflexia. Br J Urol 1995; 75 (4): 452–6.
31. Halaska M, Ralph G, Wiedemann A et al. Controlled, double-blind, multicentre clinical trial to investigate long-term tolera-bility and efficacy of trospium chloride in patients with detrusor instability. World J Urol 2003; 20 (6): 392–9.
32. Junemann KP, Al-Shukri S. Efficacy and tolerability of trospium chloride and tolterodine in 234 patients with urge syndrome: a double-blind, placebo-controlled, multicentre, clinical trial [abstract]. Neurourol Urodyn 2000; 19 (4): 488–90.
33. Notz HJ, Hautumm B et al. Trospium chloride once daily for overactive bladder syndrome: results of a multicenter observational study. Urologe A 2013; 52 (1): 65–70.
34. Staskin D, Kay G, Tannenbaum C et al. Trospium chloride has no effect on memory testing and is assay undetectable in the central nervous system of older patients with overactive bladder. Int J Clin Pract 2010; 64 (9): 1294–300.
35. Geller EJ, Dumond JB, Bowling JM et al. Effect of Trospium Chloride on Cognitive Function in Women Aged 50 and Older: A Randomized Trial. Female Pelvic Med Reconstr Surg 2017; 23 (2): 118–23.
36. Isik AT, Celik T et al. Trospium and cognition in patients with late onset Alzheimer disease. J Nutr Health Aging 2009; 13 (8): 672–6.
37. Araklitis G, Thiagamoorthy G, Hunter J et al. Anticholinergic prescription: are healthcare professionals the real burden? Int Urogynecol J 2017; 28 (8): 1249–56.
________________________________________________
2. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (9): 2672–713.
3. Bosch J, Lonn E, Yusuf S; HOPE-3 Investigators. The effect of blood pressure and cholesterol lowering on cognition. Program and abstracts of the American Heart Association 2016 Scientific Sessions; November 13, 2016; New Orleans, Louisiana. Abstract LBCT-01.
4. Staessen JA, Thijs L, Richart T et al. Placebo-controlled trials of blood pressure-lowering therapies for primary prevention of dementia. Hypertension 2011; 57: e6–7.
5. Chang-Quan H, Hui W, Chao-Min W et al. The association of antihypertensive medication use with risk of cognitive decline and dementia: a meta-analysis of longitudinal studies. Int J Clin Pract 2011; 65 (12): 1295–305.
6. Petrella RJ, Shlyakhto E, Konradi AO et al. Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of theObservational Study on Cognitive Function and SBP Reduction (OSCAR) study. J Clin Hypertens (Greenwich) 2012; 14 (2): 78–84.
7. Kume K, Hanyu H, Sakurai H et al. Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer’s disease. Geriatr Gerontol Int 2012; 12 (2): 207–14.
8. Chiu WC, Ho WC, Lin MH et al. Angiotensin receptor blockers reduce the risk of dementia. J Hypertens 2014; 32: 938–47.
9. Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2012; 75 (1): 79–92.
10. Pase MP, Beiser A, Himali JJ et al. Aortic Stiffness and the Risk of Incident Mild Cognitive Impairment and Dementia. Stroke 2016; 47: 2256–61.
11. Mattace-Raso F, van der Cammen TJM, Hofman A et al. Arterial Stiffness and Risk of Coronary Heart Disease and Stroke. The Rotterdam Study. Circulation 2006; 113: 657–63.
12. Toescu EC, Xiong J. Metabolic substrates of neuronal aging. Ann N Y Acad Sci 2004; 1019: 19–23.
13. Bachmeier C, Beaulieu-Abdelahad D, Mullan M, Paris D. Selective dihydropyiridine compounds facilitate the clearance of beta-amyloid across the blood–brain barrier. Eur J Pharmacol 2011; 659: 124–9.
14. Paris D, Bachmeier C, Patel N et al. Selective antihypertensive dihydropyridines lower Ab accumulation by targeting both the production and the clearance of Ab across the blood-brain barrier. Mol Med 2011; 17: 149–62.
15. Corbett A, Pickett J, Burns A et al. Drug repositioning for Alzheimer’s disease. Nature Reviews Drug Discovery 2012; 11: 833–46.
16. Watfa G, Rossignol P, Kearney-Schwartz A et al. Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints. J Hypertens 2010; 28 (12): 2485–93.
17. Trompet S et al. Use of calcium antagonists and cognitive decline in old age. The Leiden 85-plus study. Neurobiol Aging 2008; 29 (2): 306–8.
18. Staessen JA, Fagard R, Thijs L. et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
19. Thijs L, Staessen JA, Beleva S et al. How well can blood pressure be controlled? Progress report on the Systolic Hypertension in Europe Follow-Up Study (Syst-Eur 2). Curr Control Trials Cardiovasc Med 2001; 2: 298–306.
20. Tuomilehto J et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
21. Liu L, Wang JG, Gong L et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertension 1998; 16: 1823–9.
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Авторы
Ю.В.Котовская*1,2, В.С.Остапенко2, О.Н.Ткачева2
1 ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, Москва, ул. Миклухо-Маклая, д. 6;
2 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*kotovskaya@bk.ru
1 People’s Friendship University of Russia. 117198, Russian Federation, Moscow, ul. Miklukho-Maklaia, d. 6;
2 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*kotovskaya@bk.ru
1 ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, Москва, ул. Миклухо-Маклая, д. 6;
2 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*kotovskaya@bk.ru
________________________________________________
1 People’s Friendship University of Russia. 117198, Russian Federation, Moscow, ul. Miklukho-Maklaia, d. 6;
2 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*kotovskaya@bk.ru
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