cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1816Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТОНИЯARTERIAL HYPERTENSIONСравнение рекомендованных доз блокаторов рецепторов ангиотензина и ингибиторов ангиотензинпревращающего фермента (исследование CORD)Comparing recommended doses of angiotensin receptor blockers and ACE inhibitors (CORD Study)SpinarJ.SpinarJ.

Медицинский Факультет.

Брно

Head of Internal Cardiology Department, University Hospital Brno, Medical Faculty MU.

Brno,tel.: 420532232601, fax: 420532232611

jspinar@fnbrno.czVftovecJ.VftovecJ.

Медицинский Факультет.

Брно

Head of Internal Cardiology Department, St Ann University Hospital, Medical Faculty MU.

Brno

 

SoucekM.SoucekM.

Медицинский Факультет.

Брно

Head of Internal Depatment, St Ann University Hospital, Medical Faculty MU.

Brno

 

DusekL.DusekL.

Медицинский Факультет.

Брно

Head of Department of Statistical Analysis, Medical Faculty MU.

Brno

 

PavlikT.PavlikT.

Медицинский Факультет.

Брно

T. Pavlik для исследования CORD

Vice head of Department of Statistical Analysis, Medical Faculty MU.

Brno

T. Pavlik for CORD Study

Университет МасарикаЧехияMasarik UniversityCzech Republic200920082009846370Copyright © Spinar J., Vftovec J., Soucek M., Dusek L., Pavlik T., 20092009Spinar J., Vftovec J., Soucek M., Dusek L., Pavlik T.Spinar J., Vftovec J., Soucek M., Dusek L., Pavlik T.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/1816Цель

Цель. В исследовании CORD оценивались эффективность и переносимость лозартана и рамиприла у пациентов с артериальной гипертонией (АГ).

Материал и методы

Материал и методы. В исследовании участвовали две группы: В группе A больных переводили с лечения ингибиторами ангиотензин-превращающего фермента (ИАПФ) на лозартан; участвовали 4016 больных с АД < 160/100 мм рт.ст., принимавших различные ИАПФ в течение > 3 мес.; средний возраст пациентов — 62,6+11,6 лет; 53,1% этой выборки составляли женщины. АД, частота сердечных сокращений, биохи­мические показатели, общий анализ крови и ЭКГ контролировались в первый день и затем через 1, 3, 6 и 12 мес. В группе B сравнивались эффективность и переносимость лозартана и рамиприла. В эту группу вошли 3813 больных с АД > 140/90 мм рт.ст., ранее не принимавших блокаторы рецепторов ангиотензина (БРА) или ИАПФ; средний возраст пациентов — 60,5+12,2 лет; 50,5% из них были женщины. Пациенты случайным образом разделены на группы лечения лозартаном 50 мг/сут. (n=1887) или рамиприлом 5 мг/ сут. (n=1926).

Результаты

Результаты. Через 1 мес. лечения в группе А понизилось АД со 147,4+14,8/87,7+9,3 мм рт.ст. до 139,7+11,8/83,0+9,3 мм рт.ст. (p<0,001), а через 1 год — до 133,7+11,3/79,1+7,06 мм рт.ст. (p<0,001). Частота развития побочных эффектов не увеличилась. Через 1 год в группе В, подгруппе лозартана АД снизилось со 156,5+13,1/93,4+8,8 до 134,55+11,3/80,16+6,6 мм рт.ст. (p<0,001), а в подгруппе рами­прила — со 155,9+13,1/93,0+8,9 мм рт.ст. до 134,1+11,2/81,5+6,8 мм рт.ст. (p<0,001). Серьезных побочных эффектов не наблюдалось, но в подгруппе рамиприла сухой кашель появился в 8 раз чаще.

Заключение

Заключение. Переход с терапии ИАПФ на лозартан безопасен и эффективен. Лозартан и рамиприл обладают равной антигипертензивной эффективностью и тенденцией к улучшению метаболических показателей; терапия лозартаном переносилась значительно лучше по сравнению с рамиприлом.

Aim

Aim. The CORD Study compared effectiveness and tolerability of losartan and ramipril in patients with arterial hypertension (AH).

Material and methods

Material and methods. The study included two groups, A and B. In Group A (n=4016; mean age 62,6+11,6 years; 53,1% women), the patients with blood pressure (BP) <160/100 mm Hg and ACE inhibitor therapy lasting for >3 months were switched from ACE inhibitors to losartan. At baseline and 1, 3, 6, and 12 months later, BP, heart rate, and biochemical parameters were measured; general blood assay and electrocardiography (ECG) were also performed. In group B (n=3813; mean age 60,5+12,2 years; 50,5% women), the patients with BP >140/90 mm Hg and no previous ACE inhibitor or angiotensin receptor blocker (ARB) therapy were randomly administered either losartan (50 mg/d; n=1887) or ramipril (5 mg/d; n=1926).

Results

Results. Group A demonstrated a decrease in BP — from 147,4+14,8/87,7+9,3 to 139,7+11,8/83,0+9,3 mm Hg (p<0,001) after one month of the treatment, and to 133,7+11,3/79,1+7,06 mm Hg (p<0,001) after one year. Adverse effect prevalence did not increase. After one year, Group B demonstrated a reduction in BP levels — in losartan subgroup, from 156,5+13,1/93,4+8,8 to 134,55+11,3/80,16+6,6 mm Hg (p<0,001), and in ramipril subgroup — from 155,9+13,1/93,0+8,9 to 134,1+11,2/81,5+6,8 mm Hg (p<0,001). No severe adverse effects were registered, but in ramipril subgroup, cough was 8 times more prevalent.

Conclusion

Conclusion. ACE inhibitor substitution with losartan was safe and effective. Losartan and ramipril demonstrated equal antihypertensive effectiveness and a tendency to improve metabolic parameters. Losartan therapy was better tolerated than ramipril.

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