cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2011-5-92-98cardiovascular-1946Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMАнтигипертензивная эффективность монотерапии олмесартаном медоксомилом в сравнении с комбинированной терапией другими блокаторами рецепторов к ангиотензину II и гидрохлортиазидомA review of olmesartan medoxomil monotherapy: antihypertensive efficacy similar to that of other angiotensin II receptor blocker/hydrochlorothiazide combinations?ГрейтхаусМ.GreathouseM.

Питтсбург

Pittsburgh

Allegheny General Hospital, West Penn Allegheny Health SystemAllegheny General Hospital, West Penn Allegheny Health System2011201020111059298Copyright © Грейтхаус М., 20112011Грейтхаус М.Greathouse M.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/1946

Блокаторы рецепторов к ангиотензину II (БРА) применяются в США, начиная с 1995г. Эти препараты продемонстрировали антигипертензивную эффективность, по меньшей мере, не уступающую таковой для других классов антигипертензивных лекарственных средств (АГП). Согласно результатам недавно выполненных крупных рандомизированных, контролируемых, клинических исследований, БРА обладают кардио, вазо- и нефропротективными свойствами, не зависящими от их влияния на уровни системного артериального давления (АД). Эти качества позволяют рассматривать БРА как препараты первой линии, особенно у больных высокого риска. Тем не менее, так же как и для иных классов АГП, монотерапия «старыми» БРА (лозартан калия, валсартан и ирбесартан) не способна обеспечить адекватное снижение АД и достижение целевых уровней АД у значительной доли пациентов с гипертензией (АГ). Для потенцирования антигипертензивного эффекта БРА эти препараты зачастую назначают совместно с диуретиком гидрохлортиазидом (Гхт). В ряде исследований, непосредственно сравнивавших эффекты терапии отдельными БРА, были продемонстрированы различия этих препаратов по их антигипертензивному действию. В частности, в недавно выполненном, проспективном, рандомизированном исследовании терапия новым БРА олмесартаном медоксомилом напрямую сравнивалась с лечением лозартаном калием, ирбесартаном и валсартаном. Было показано, что олмесартан медоксомил вызывал достоверно более выраженное снижение диастолического АД (ДАД) (основная конечная точка), по сравнению с тремя другими БРА. Было продемонстрировано, что абсолютное снижение ДАД на фоне монотерапии олмесартаном медоксомилом сопоставимо с таковым при комбинированной терапии другими БРА и Гхт. Эти результаты могут иметь важное клиническое значение при выборе оптимальной антигипертензивной терапии (АГТ) первой линии.

Angiotensin II receptor blockers (ARBs) have been available in the United Statessince 1995. These agents have demonstrated antihypertensive efficacy at least similar to that of agents from other antihypertensive classes. Recent large-scale, randomized, controlled clinical trials have demonstrated that ARBs offer cardiovascular and renal protective benefits independent of their effects on systemic blood pressure (BP), which make them valuable as first-line antihypertensive agents, especially in high-risk patients. However, as is the case with other antihypertensive classes, monotherapy with the first available ARBs (losartan potassium, valsartan, and irbesartan) may not provide sufficient BP reduction to achieve currently recommended BP goals in many patients. The diuretic hydrochlorothiazide is frequently added to enhance the ability of ARBs to lower BP. Several head-to-head comparison studies have shown differences in antihypertensive efficacy among the available ARBs. The newest ARB, olmesartan medoxomil, was recently compared with losartan potassium, irbesartan, and valsartan in a prospective, head-to-head, randomized trial. In this study, olmesartan medoxomil demonstrated a significantly greater reduction in diastolic BP, the primary end point, compared with the other three ARBs. Further, a review of the absolute reductions in diastolic BP achieved with olmesartan medoxomil monotherapy appears comparable to that of previously available ARBs when they are used in combination with hydrochlorothiazide. These comparisons may have important clinical implications regarding the optimal choice of first-line antihypertensive therapy.

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