Журнал "Медицинский совет. Кардиология" № 5, 2018
Ю.А. Карпов, д.м.н., профессор, Национальный медицинский исследовательский центр кардиологии Минздрава России
Основной задачей лечения пациентов с АГ является снижение риска развития сердечно-сосудистых осложнений через достижение целевого уровня артериального давления (АД) и органопротекции, лечение сопутствующих заболеваний и коррекцию факторов риска. В недавно представленных новых американских рекомендациях по ведению пациентов АГ указывается, что целевым уровнем АД для всех пациентов стало меньше 130/80 мм рт. ст. Это связано в т. ч. с изменением классификации уровней АД и признания пациентами АГ всех взрослых лиц с АД 130/80 мм рт. ст. и выше. Необходимость не только более широкого проведения комбинированной терапии в лечении пациентов АГ, но и более раннего ее применения нашла весьма яркое подтверждение в этих новых рекомендациях по ведению пациентов АГ. Более широкое применение комбинаций, особенно в фиксированных дозах, как блокатора кальциевых каналов амлодипина, так и блокатора рецепторов ангиотензина II олмесартана в лечении АГ будет способствовать улучшению контроля АД, снижению риска осложнений и увеличению продолжительности жизни больных АГ.
Yu.A. Karpov, MD.Prof., National Medical Research Centre of Cardiology of the Ministry of Health of Russia, Moscow
New perspectives for the treatment of arterial hypertension: 2017 american guidelines
The key goal in the treatment for patients with AH is to reduce the risk of cardiovascular complications through reaching the target level of arterial pressure (AP) and organ protection, treatment of concomitant diseases and correction of risk factors. The new US guidelines for the management of hypertension indicate that the target blood pressure level for all patients was less than 130/80 mm Hg. This is due, among other things, to changing the blood pressure levels classification and categorizing all adults with blood pressure of 130/80 mm Hg. and higher as having hypertension. The need for not only wider combination therapy for the treatment of hypertensive patients, but also its earlier commencement has been strongly confirmed by these new guidelines for the management of AH. The wider use of combinations, especially in fixed doses, such as the calcium channel blocker amlodipine, and the angiotensin II receptor antagonist olmesartan for the treatment of hypertension, will help improve blood pressure monitoring, reduce the risk of complications and increase the AH patients’ life expectancy.
Список литературы
1. Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и соавт. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных АГ. Кардиология 2014, 10: 4-12.
2. Клинические рекомендации «Диагностика и лечение артериальной гипертензии» Российского медицинского общества по артериальной гипертонии. Кардиологический вестник, 2015, 1(10): 5-30.
3. Mancia G, Fagard R, Narkiewicz K, et al. Task Force Members. 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(7): 1281-1357.
4. Wright JT Jr, Williamson JD, Whelton PK, et al.A randomized trial of intensive versus standard blood-pressure control. SPRINT Research Group. N Engl J Med, 2015, 373: 2103-16.
5. Piepoli MF, Hoes AW, Agewall S, et al. Authors/ Task Force Members. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J, 2016, 37: 2315-2381.
6. Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison, Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, Mac Laughlin EJ, Muntner P, Ovbiagele B, Smith Jr SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams Sr KA, Williamson JD, Wright Jr JT, 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. JACC, 2017. doi: 10.1016/j.jacc.2017.11.006.
7. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension. 2010, 55: 399-407.
8. Puchler K, Laies P, Stumpe K. Blood pressure response, but not adverse event incidence, correlates with dose of angiotensin II antagonist.J Hypertens, 2001, 19(Suppl.): S41-S48.
9. Punzi HA. Efficacy and safety of olmesartan medoxomil alone and in combination with hydrochlorothiazide. Expert Rev Cardiovasc Ther, 2009, 7: 229-239.
10. Norwood D, Branch E, Smith B et al. Olmesartan medoxomil for hypertension: a clinical review. Drug. Forecast., 2002, 27: 611-618
11. Brunner HR, Stumpe KO, Januszewicz A. Antihypertensive efficacy of olmesartan medoxomil and candesartan cilexitil assessed by 24-hour ambulatory blood pressure monitoring in patients with essential hypertension. Clin Drug Invest, 2003, 23: 419-430.
12. Oparil S, Williams D, Chrysant SG et al. Comparative efficacy of olmesartan, losartan, valsartan, and irbesartan in the control of essential hypertension. J Clin Hypertens, 2001, 3: 283-291.
13. Williams P.A. A multi-centre, double-blind, efficacy, tolerability and safety study of the oral angiotensin II antagonist olmesartan medoxomil versus captopril in patients with mild to moderate essential hypertension. J Hypertens, 2001, 19(suppl. 2): 300.
14. Haller H, Sadayoshi I, Izzo JL, et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med, 2011, 364: 907-17.
15. Sever PS, Dahlof B, Poulter NR, et al, for the ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet, 2005, 366: 895-906.
16. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with valsartan- or amlodipine-based regimens: VALUE, a randomised trial. Lancet, 2004, 363: 2022-31.
17. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. Circulation, 2000, 102: 1503-1510.
18. Nissen SE, Tuzcu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure. The CAMELOT study: a randomized controlled trial. JAMA, 2004, 292: 2217-2226.
19. The ALLHAT Officers and Coordinators. Major outcomes in high-risk hypertensive patients randomized to ACE inhibitor or calcium channel blocker vs diuretic (ALLHAT). JAMA, 2002, 288: 2981-2997.
20. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients.N Engl J Med, 2008, 359(23): 2417-28.
21. Chrysant S, Melino M, Karki S, Lee J, Heyrman R. The combination of olmesartan medoxomil and amlodipine besylate in controlling high blood pressure: COACH, a randomized, double-blind, placebocontrolled, 8-week factorial efficacy and safety study. Clin Ther, 2008, 30(4): 587-604.
22. Volpe M, Brommer P, Haag U, Miele C. Efficacy and tolerability of olmesartan medoxomil combined with amlodipine in patients with moderate to severe hypertension after amlodipine monotherapy: a randomized, double-blind, parallel-group, multicentre study. Clin Drug Investig, 2009, 29(1): 11-25.
23. Barrios V, Brommer P, Haag U, Calderon A, Escobar C. Olmesartan medoxomil plus amlodi-pine increases efficacy in patients with moderate-to-severe hypertension after monotherapy: a randomized, double-blind, parallel-group, multicentre study. Clin Drug Investig, 2009, 29(7): 427-439.
24. Weir MR, Hsueh WA, Nesbitt SD, et al. Effects on BP control of amlodipine/olmesartan medoxomil, with or without hydrochlorothiazide, in patients not controlled by prior anti-hypertensive monotherapy (late breaker at the American Society of Hypertension 25th Annual Scentific Meeting, New York). J Clin Hypertens (Greenwich), 2010, 12(7): 536.
25. Punzi H, Neutel JM, Kereiakes DJ, et al. Efficacy of amlodipine and olmesartan medoxomil in patients with hypertension: the AZOR Trial Evaluating Blood Pressure Reductions and Control (AZTEC) study. Ther Adv Cardiovasc Dis, 2010, 4(4): 209-221.
