cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2011-2-116-121cardiovascular-1914Research ArticleОБЗОРЫREVIEWSРоль оксида азота в улучшении функции эндотелия и сердечно-сосудистого здоровья: фокус на небивололThe role of nitric oxide in improving endothelial function andcardiovascular health: focus on nebivololBakrisG. L.BakrisG. L.

Chicago

Chicago

BasileJ. N.BasileJ. N.

Charleston

Charleston

GilesT. D.GilesT. D.

New Orleans

New Orleans

TaylorA. A.TaylorA. A.

Houston

Houston

Hypertensive Diseases Unit, Department of Medicine, University of Chicago Medical CenterHypertensive Diseases Unit, Department of Medicine, University of Chicago Medical CenterSeinsheimer Cardiovascular Health Program, College of Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical CenterSeinsheimer Cardiovascular Health Program, College of Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical CenterDepartment of Medicine, Tulane University School of MedicineDepartment of Medicine, Tulane University School of MedicineDepartments of Medicine, Pharmacology, and Molecular Physiology, Baylor College of MedicineDepartments of Medicine, Pharmacology, and Molecular Physiology, Baylor College of Medicine201120042011102116121Copyright © Bakris G.L., Basile J.N., Giles T.D., Taylor A.A., 20112011Bakris G.L., Basile J.N., Giles T.D., Taylor A.A.Bakris G.L., Basile J.N., Giles T.D., Taylor A.A.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/1914

Согласно современным клиническим рекомендациям, β-адреноблокаторы (β-АБ) показаны для лечения пациентов с артериальной гипертензией (АГ), в особенности, с выраженной сердечно-сосудистой патологией и высоким сердечно-сосудистым риском. Определенную настороженность вызывают данные о связи терапии традиционными β-АБ с неблагоприятными клиническими исходами, по сравнению с другими классами антигипертензивных препаратов (АГП). Прием традиционных β-АБ может ассоциироваться с ухудшением качества жизни, а также липидного и углеводного обменов. β-АБ представляют собой разнородную группу АГП, включающую неселективные препараты, кардиоселективные препараты без вазодилатирующих свойств, а также вазодилатирующие препараты, сочетающие неселективность в отношении β-рецепторов с α-блокирующим действием, либо кардиоселективность с отсутствием α-блокады. В обзоре обсуждаются фармакологические и гемодинамические различия между традиционными β-АБ без вазодилатирующей активности и вазодилатирующими β-АБ, с фокусом на небиволол — кардиоселективный β-АБ с вазодилатирующими свойствами. Данные различия могут иметь важное клиническое значение, в частности, при лечении осложненной АГ (например, у пациентов с сахарным диабетом, кардиометаболическим синдромом, пожилых больных и пациентов афроамериканского происхождения). Таким образом, при выборе того или иного β-АБ следует учитывать механизм его действия.

Although β-blockers have been endorsed by guidelines committees for the treatment of patients with hypertension, particularly those with significant CVD and high CVD risk, there are concerns about conventional β-blockers related to poorer clinical outcomes compared with other classes of antihypertensive agents, as well as deleterious effects on quality of life and lipid and carbohydrate metabolism. β-blockers comprise a heterogeneous group of antihypertensive agents, including nonselective agents, cardioselective, nonvasodilating agents, and vasodilating agents that either combine β-nonselectivity with β-blockade or possess cardioselectivity without β-blockade. The pharmacologic, mechanistic, and hemodynamic differences between conventional, nonvasodilating β-blockers and vasodilating β-blockers are discussed in this review, with a focus on the cardioselective vasodilating β-blocker nebivolol. These differences may have important clinical implications, particularly in the treatment of complicated hypertension, such as that associated with patients with diabetes or cardiometabolic syndrome, elderly patients, and African American patients, suggesting that mechanism of action may be an important consideration when choosing a β-blocker.

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