cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1433Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMКандесартана цилексетил в превентивной терапии сердечно-сосудистых заболеванийCandesartan cilexetil in cardiovascular preventionИвлеваА. Я.IvlevaA. Ya.ayai@pmc.ruФГУ «Поликлиника №3» Управления делами Президента РФ, МоскваРоссияOut-Patient Department No. 3, RF President Administration, MoscowRussian Federation200720122007668390Copyright © Ивлева А.Я., 20072007Ивлева А.Я.Ivleva A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1433

Эффективность и хорошая переносимость блокаторов ангиотензиновых рецепторов при артериальной гипертонии (АГ) доказаны в рандомизированных, широкомасштабных, клинических исследованиях. Установлены существенные фармакодинамические различия между препаратами, блокирующими ангиотензиновые рецепторы, что имеет потенциально важное клиническое значение. Доказано преимущество кандесартана по степени и длительности снижения артериального давления (АД) при АГ и уменьшение частоты сердечно-сосудистых осложнений при длительном лечении АГ кандесартаном. Благоприятное влияние кандесартана на метаболизм отмечено у пациентов с сахарным диабетом, независимо от антигипертензивного эффекта. В контролируемых исследованиях с применением кандесартана при хронической сердечной недостаточности полностью доказана их эффективность как в комплексной терапии при назначении кандесартана в комбинации с E-адреноблокатором, так и при дополнительном присоединении к комбинации E-адреноблокатора с ингибитором ангиотензин-превращающего фермента.

Effectiveness and good tolerability of angiotensin receptor antagonists (ARA) in arterial hypertension (AH) have been demonstrated in large-scale randomized clinical trials. Substantial pharmacodynamic differences between various ARA, potentially playing important clinical roles, were identified. Candesartan benefits in regard to stage and duration of blood pressure (BP) reduction, as well as cardiovascular event risk reduction, were shown for long-term AH treatment with the agent. Metabolic benefits of candesartan, independent of BP reduction, were observed in diabetic patients. Candesartan is also effective in chronic heart failure, combined with beta-adrenoblocker, or with beta-adrenoblocker and ACE inhibitor.

артериальная гипертониясахарный диабетхроническая сердечная недостаточностькандесартанфармакодинамикаarterial hypertensiondiabetes mellituschronic heart failurecandesartanpharmacodynamicsReferencesCipollone F, Fasia M, Iezzi A, et al. Blockade of the angiotensin II type 1 receptor stabilizes atherosclerotic plagues in humans by inhibiting prostaglandin E2-dependent matrix metalloproteinase activity. Circulation 2004; 109: 1482-8.Cipollone F, Fasia M, Iezzi A, et al. Blockade of the angiotensin II type 1 receptor stabilizes atherosclerotic plagues in humans by inhibiting prostaglandin E2-dependent matrix metalloproteinase activity. Circulation 2004; 109: 1482-8.Candido R, Allen TJ, Lassila M, et al. Irbesartan but not amlodipine suppresses diabetes-associated atherosclerosis. Circulation 2004; 109: 1536-42.Candido R, Allen TJ, Lassila M, et al. Irbesartan but not amlodipine suppresses diabetes-associated atherosclerosis. Circulation 2004; 109: 1536-42.2003 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011-53.2003 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011-53.Dzau V. The cardiovascular continuum and rennin-angiotensin-aldosterone system blockade. J Hypertens 2005; 23(Suppl): S9-17.Dzau V. The cardiovascular continuum and rennin-angiotensin-aldosterone system blockade. J Hypertens 2005; 23(Suppl): S9-17.Cohn JN, Tognoni G. A randomised trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001; 345: 1667-75.Cohn JN, Tognoni G. A randomised trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001; 345: 1667-75.Granger CB, McMurray JJ, Yusuf S, et al Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function intolerant to angiotensin converting enzime inhibitors: the CHARM-Alternative trial. Lancet 2003; 362: 772-6.Granger CB, McMurray JJ, Yusuf S, et al Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function intolerant to angiotensin converting enzime inhibitors: the CHARM-Alternative trial. Lancet 2003; 362: 772-6.McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function taking angiotensin converting enzime inhibitors: the CHARM-Added trial. Lancet 2003; 362: 767- 71.McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function taking angiotensin converting enzime inhibitors: the CHARM-Added trial. Lancet 2003; 362: 767- 71.Morsing P, Adler G, Brandt U, et al. Mechanistic Differences of various AT1-receptor blockers in isolated vessele of different origin. Hypertension 1999; 33: 1406-13.Morsing P, Adler G, Brandt U, et al. Mechanistic Differences of various AT1-receptor blockers in isolated vessele of different origin. Hypertension 1999; 33: 1406-13.Ojima M, Inada Y, Shibouta Y, et al. Candesartan (CV-11974) dissociates slowly from the angiotensin AT1-receptor Eur J Pharmacol 1997; 319: 137-46.Ojima M, Inada Y, Shibouta Y, et al. Candesartan (CV-11974) dissociates slowly from the angiotensin AT1-receptor Eur J Pharmacol 1997; 319: 137-46.Elmfeldt B, Meredith P. The relationship between dose and antihypertensive effect of four AT1-receptor blockers. Differences in potency and efficacy. Blood Рressure 2002; 11: 293-301.Elmfeldt B, Meredith P. The relationship between dose and antihypertensive effect of four AT1-receptor blockers. Differences in potency and efficacy. Blood Рressure 2002; 11: 293-301.Сlinical comparative trials of angiotensin II type 1 (AT1) – receptor blockers. Blood Pressure 2001; 10(Suppl 3): 11-7.Сlinical comparative trials of angiotensin II type 1 (AT1) – receptor blockers. Blood Pressure 2001; 10(Suppl 3): 11-7.Timmermans PB. Pharmacologic properties of angiotensin II receptor antagonists. Can J Cardiol 1999;15(Suppl F); 26F-8.Timmermans PB. Pharmacologic properties of angiotensin II receptor antagonists. Can J Cardiol 1999;15(Suppl F); 26F-8.Cuspidi C, Muiesan ML, Valagussa L, et al. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertensio: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J Hypertens 2002; 20: 2293-300.Cuspidi C, Muiesan ML, Valagussa L, et al. Comparative effects of candesartan and enalapril on left ventricular hypertrophy in patients with essential hypertensio: the candesartan assessment in the treatment of cardiac hypertrophy (CATCH) study. J Hypertens 2002; 20: 2293-300.Ariff B, Zambanini A, Vamadeva S, et al. Differing effects of candesartan cilexetil and atenolol on carotid artery remodelling and carotid flow in hypertension. Circulation 2003; 108(17Suppl): IV-452. Abstract.Ariff B, Zambanini A, Vamadeva S, et al. Differing effects of candesartan cilexetil and atenolol on carotid artery remodelling and carotid flow in hypertension. Circulation 2003; 108(17Suppl): IV-452. Abstract.Ariff B, O’Neill A, Stanton A, et al. Candesartan cilexetil and atenolol have different effects on common carotid artery remodelling in hypertension. J Hypertens 2003; 21: S153-4. Abstract.Ariff B, O’Neill A, Stanton A, et al. Candesartan cilexetil and atenolol have different effects on common carotid artery remodelling in hypertension. J Hypertens 2003; 21: S153-4. Abstract.Wassmann S, Hilgers S, Laufs U, et al. Angiotensin II type 1 receptor antagonism improves hypercholesterolemia-associated endothelial dysfunction. Arterioscler Thromb Vasc Biol 2002; 22: 1208-12.Wassmann S, Hilgers S, Laufs U, et al. Angiotensin II type 1 receptor antagonism improves hypercholesterolemia-associated endothelial dysfunction. Arterioscler Thromb Vasc Biol 2002; 22: 1208-12.Gradman AH, Lewin A, Bowling BT, et al. Comparative effects of candesartan cilexetil and losartan in patients with systemic hypertension. Candesartan Versus Losartan Efficacy Comparison (CANDLE) Study Group. Heart Dis 1999; 1: 52-7.Gradman AH, Lewin A, Bowling BT, et al. Comparative effects of candesartan cilexetil and losartan in patients with systemic hypertension. Candesartan Versus Losartan Efficacy Comparison (CANDLE) Study Group. Heart Dis 1999; 1: 52-7.Bakris G, Gradman A, Reif M, et al. Antihypertensive efficacy of candesartan in comparison to losartan: the CALM study. J. Clin Hypertens 2001; 3: 16-21.Bakris G, Gradman A, Reif M, et al. Antihypertensive efficacy of candesartan in comparison to losartan: the CALM study. J. Clin Hypertens 2001; 3: 16-21.Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation 1991; 83: 1849-65.Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation 1991; 83: 1849-65.Klingbell AU, Schneider M, Martus P, et al. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003; 115: 41-6.Klingbell AU, Schneider M, Martus P, et al. A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 2003; 115: 41-6.Staessen JA, Wang JG, Thijs L. Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 march 2003. J Hypertens 2003; 21: 1055-76.Staessen JA, Wang JG, Thijs L. Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 march 2003. J Hypertens 2003; 21: 1055-76.Schrader J, Luders S, Kulschewski A, et al. The ACCESS Study. Evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 2003; 34: 1699-703.Schrader J, Luders S, Kulschewski A, et al. The ACCESS Study. Evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 2003; 34: 1699-703.Trenkwalder P, Elmfeldt D, Hofman A, et al. The Study on Cognition and Prognosis in the Elderly (SCOРE): Principal results in subgroups of patients. Blood Press 2005; 14: 31-7.Trenkwalder P, Elmfeldt D, Hofman A, et al. The Study on Cognition and Prognosis in the Elderly (SCOРE): Principal results in subgroups of patients. Blood Press 2005; 14: 31-7.Lundkvist J, Ekman M, Kartman B, et al. The cost-effectiveness of candesartan-based antihypertensive treatment for the prevention of nonfatal stroke: Results from the Study on Cognition and Prognosis in the Elderly (SCOPE). J Hum Hypertens 2005; 19: 569-76.Lundkvist J, Ekman M, Kartman B, et al. The cost-effectiveness of candesartan-based antihypertensive treatment for the prevention of nonfatal stroke: Results from the Study on Cognition and Prognosis in the Elderly (SCOPE). J Hum Hypertens 2005; 19: 569-76.Julius S, Nessbitt SD, Egan BM, et al. Feasibility of treating pre-hypertension with an angiotensin-receptor blocker. (TROPHY). N Engl J Med 2006; 354-7.Julius S, Nessbitt SD, Egan BM, et al. Feasibility of treating pre-hypertension with an angiotensin-receptor blocker. (TROPHY). N Engl J Med 2006; 354-7.Lindholm LH, Person M, Alaupovic P, et al. Metabolic outcome in newly detected hypertensives: results of the Antihypertensive Treatment and Lipid Profile in North of Sweden Efficacy Evaluation (ALPINE) J Hypertension 2003; 21: 1563-74.Lindholm LH, Person M, Alaupovic P, et al. Metabolic outcome in newly detected hypertensives: results of the Antihypertensive Treatment and Lipid Profile in North of Sweden Efficacy Evaluation (ALPINE) J Hypertension 2003; 21: 1563-74.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998; 317: 703-13.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998; 317: 703-13.Lindholm LH, Ibsen H, Borch-Johsen K, et al. Risk of new-onset diabetes in the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2002; 20: 1879-86.Lindholm LH, Ibsen H, Borch-Johsen K, et al. Risk of new-onset diabetes in the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2002; 20: 1879-86.Julius S, Kjeldsen SE, Weber M, et al., for the VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet 2004; @http://image.the-lancet.com/extras/04art4187web.pdf.Julius S, Kjeldsen SE, Weber M, et al., for the VALUE trial group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet 2004; @http://image.the-lancet.com/extras/04art4187web.pdf.Dahlof B, Devereux RB, Kjeldsen SE, et al., for the LIFE study group. 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.Dahlof B, Devereux RB, Kjeldsen SE, et al., for the LIFE study group. 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.Yusuf S, Ostergren JB, Gersein HC, et al. Assessment of Reduction in Mortality and Morbidity Program (CHARM). Effects of candesartan on the development of a new diagnosis of diabetes mellitus in patients with heart failure. Circulation 2005; 112: 48-53.Yusuf S, Ostergren JB, Gersein HC, et al. Assessment of Reduction in Mortality and Morbidity Program (CHARM). Effects of candesartan on the development of a new diagnosis of diabetes mellitus in patients with heart failure. Circulation 2005; 112: 48-53.Blood Pressure Lowering Treatment Trialists Collaboration. Effects of blood-pressure-lowering regimens on major cardiovascular events: results of prоspectively-designed overviews of randomised trials. Lancet 2003; 362: 1527-35.Blood Pressure Lowering Treatment Trialists Collaboration. Effects of blood-pressure-lowering regimens on major cardiovascular events: results of prоspectively-designed overviews of randomised trials. Lancet 2003; 362: 1527-35.McKelvie RS, Yusuf S, Pericak D, et al. Combination of candesartan, enalapril, and their combination in congestive heart failure. Randomised Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) pilоt study. The RESOLVD Pilоt Study Investigators. Circulation 1999; 100: 1056-64.McKelvie RS, Yusuf S, Pericak D, et al. Combination of candesartan, enalapril, and their combination in congestive heart failure. Randomised Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) pilоt study. The RESOLVD Pilоt Study Investigators. Circulation 1999; 100: 1056-64.Pfeffer MA, Swedberg K, Granger CB, et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759-66.Pfeffer MA, Swedberg K, Granger CB, et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759-66.

The authors declare that there are no conflicts of interest present.