cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2047Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMПрогностическая значимость метаболических эффектов антигипертензивных препаратов в развитии сердечнососудистых заболеваний и сахарного диабетаMetabolic effects of antihypertensive medications: prognostic role in the development of cardiovascular disease and diabetes mellitusСтроеваМ. В.StroevaM. V.

врач-кардиолог

МамедовМ. Н.MamedovM. N.

руководитель лаборатории оценки и коррекции сердечно-сосудистого риска

mmamedov@gnicpm.ruГородская больница № 49. МоскваCity Clinical Hospital No. 49. MoscowГосударственный научно-исследовательский центр профилактической медицины РосмедтехнологийState Research Centre for Preventive Medicine, Federal Agency on High Medical Technologies201020042010928085Copyright © Строева М.В., Мамедов М.Н., 20102010Строева М.В., Мамедов М.Н.Stroeva M.V., Mamedov M.N.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/2047

В последние годы большое значение уделяется метаболическим факторам риска (ФР), имеющим важное прогностическое значение в развитии сердечно-сосудистых заболеваний и сахарного диабета 2 типа. В литературе метаболические эффекты антигипертензивных препаратов активно обсуждаются. Установлено, что ингибиторы ангиотензин-превращающего фермента, антагонисты кальция и агонисты I1-имидазолиновых рецепторов (АИР) не оказывают негативного влияния на метаболические ФР, тогда как диуретики (Д) и β-адреноблокаторы могут ухудшать прогноз. В новых европейских рекомендациях α-адреноблокаторы и АИР не рассматриваются препаратами первой линии из-за отсутствия убедительных данных об их влиянии на конечные точки. В статье подробно анализируются результаты крупных международных исследований с использованием Д. В частности, обсуждается целесообразность применения тиазидных Д в малых дозах в составе комбинированной терапии у лиц с метаболическими нарушениями и высоким сердечно-сосудистым риском.

Recently, more and more attention has been paid to metabolic risk factors (RFs), due to their prognostic importance in the development of cardiovascular disease (CVD) and Type 2 diabetes mellitus. The metabolic effects of antihypertensive medications are actively discussed in the literature. It has been demonstrated that ACE inhibitors, calcium antagonists, and I1-imidasoline receptor agonists (IRA) do not affect metabolic RFs, while diuretics (D) and beta-adrenoblockers could worsen the prognosis. In the new European guidelines, alpha-adrenoblockers and IRA are not regarded as first-choice medications, due to the lacking evidence of their effects on end-points. The paper analyses in detail the results of large-scale international trials on D. In particular, the authors discuss the potential of low-dose thiazide D, as a part of combined therapy, in patients with metabolic disturbances and high cardiovascular risk.

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