cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2180Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESДинамика толщины комплекса интима-медия и объема бляшки сонных артерий на фоне двухлетней терапии антагонистом ангиотензиновых рецепторов. Исследование MORE (Multicentre Olmesartan atherosclerosis Regression Evaluation)Carotid intima-media thickness and plaque volume changes following 2-year angiotensin II-receptor blockade. The Multicentre Olmesartan atherosclerosis Regression Evaluation (MORE) studyШтумпеК. О.StumpeKl. O.Agabiti-RoseiE.Agabiti-RoseiE.

Department of Medical and Surgical Sciences

Department of Medical and Surgical Sciences

ZielinskiT.ZielinskiT.SchremmerD.SchremmerD.ScholzeJ.ScholzeJ.LaeisP.LaeisP.SchwandtP.SchwandtP.LudwigM.LudwigM.University of Bonn, Centre of Preventive Medicine, BonnUniversity of Bonn, Centre of Preventive Medicine, BonnUniversity of Brescia, BresciaUniversity of Brescia, BresciaKlinika Niewydolnosci Serca i Transplantologii, Instytut Kardiologii, WarszawaKlinika Niewydolnosci Serca i Transplantologii, Instytut Kardiologii, WarszawaGKM Gesellschaft für Therapieforschung mbH, MunichGKM Gesellschaft für Therapieforschung mbH, MunichMedizinische Poliklinik, CharitÉ-Universitätsmedizin, BerlinMedizinische Poliklinik, CharitÉ-Universitätsmedizin, BerlinDaiichi Sankyo Europe GmbH, MunichDaiichi Sankyo Europe GmbH, MunichInstitute for Atherosclerosis Prevention, MunichInstitute for Atherosclerosis Prevention, MunichUniversity of Bonn, Benediktus Krankenhaus, TutzingUniversity of Bonn, Benediktus Krankenhaus, Tutzing201001011970984654Copyright © Штумпе К.О., Agabiti-Rosei E., Zielinski T., Schremmer D., Scholze J., Laeis P., Schwandt P., Ludwig M., 19701970Штумпе К.О., Agabiti-Rosei E., Zielinski T., Schremmer D., Scholze J., Laeis P., Schwandt P., Ludwig M.Stumpe K.O., Agabiti-Rosei E., Zielinski T., Schremmer D., Scholze J., Laeis P., Schwandt P., Ludwig 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/2180

Цель. Двойное слепое, клиническое исследование MORE было выполнено у пациентов с высоким сердечно-сосудистым риском с артериальной гипертензией (АГ), утолщением стенки и атеросклеротическими бляшками (АБ) сонных артерий (СА). С помощью неинвазивного двух- и трехмерного (2D, 3D) ультразвукового исследования (УЗИ) сравнивались эффекты двухлетней терапии олмесартаном медоксомилом и атенололом на толщину комплекса интима-медия (ТКИМ) и объем АБ общих СА (ОСА). Методы. 165 пациентов с уровнем систолического и диастолического артериального давления (АД) 140- 180/90-105 мм рт.ст. были рандомизированы в отношении приема олмесартана (20-40 мг/сут.) либо атенолола (50-100 мг/сут.). УЗИ выполнялось исходно, а также на 28, 52 и 104 нед. Основным критерием эффективности терапии была динамика (Δ) показателя ТКИМ ОСА по сравнению с исходным уровнем, оценивающаяся с помощью 2D УЗИ. Дополнительными конечными точками были динамика объема АБ (ΔPV), оцениваемая с помощью 3D УЗИ, и изменение уровней АД. Результаты. Олмесартан и атенолол сопоставимо снижали показатель ТКИМ. Средние значения Δ ТКИМ составляли -0,090 мм (стандартная ошибка средней величины 0,015 мм) для олмесартана и -0,082 (0,014) мм для атенолола. Средние значения ΔPV достигали -4,4 (2,3) мкл и 0,1 (1,5) мкл, соответственно, без достоверных различий между группами (гр.) терапии. В то же время, в подгруппе пациентов с исходными показателями PV не ниже медианных значений (≥33,7 мкл) отмечались статистически достоверные различия ΔPV (р=0,023): этот показатель существенно снизился в гр. олмесартана (-11,5 (4,4) мкл), но не в гр. атенолола – 0,6 (2,5) мкл. Степень снижения АД у этих больных была сопоставимой. Заключение. Снижение показателей ТКИМ ОСА и АД было сопоставимым на фоне терапии олмесартаном и атенололом. В то же время, уменьшение объема крупных АБ наблюдалось лишь в гр. олмесартана.

Aim. The Multicentre Olmesartan atherosclerosis Regression Evaluation (MORE) study was a double-blind trial in patients with hypertension at increased cardiovascular risk with carotid wall thickening and a defined atherosclerotic plaque that used non-invasive 2- and 3-dimensional (D) ultrasound (US), to compare the effects of a 2-year treatment based on either olmesartan medoxomil or atenolol on common carotid (CC) intima-media thickness (IMT) and plaque volume (PV). Methods. A total of 165 patients (with systolic/diastolic blood pressure 140–180/90–105 mm Hg) were randomized to receive either olmesartan (20–40 mg/day) or atenolol (50–100 mg/day). US was performed at baseline and 28, 52 and 104 weeks. The primary efficacy outcome was the change from baseline (Δ) in CC-IMT assessed by 2D US. Secondary outcomes included ΔPV assessed by 3D US and blood pressure (BP). Results. Olmesartan and atenolol produced comparable significant reductions in CC-IMT; mean ΔIMT (SEM) was −0,090 (0,015) mm for olmesartan and −0,082 (0,014) mm for atenolol. Mean ΔPV was −4,4 (2,3) μl and 0,1 (1,5) μl in the olmesartan and atenolol treated subjects, respectively, without significant between-treatment differences. In the subgroup of patients with baseline PV ≥ median (33,7 μl), significant between-treatment differences existed in ΔPV (p=0,023), because PV regressed significantly with olmesartan (ΔPV: −11,5 (4,4) μl) but not with atenolol (ΔPV: 0,6 (2,5) μl). In these patients BP reductions were comparable. Conclusion. Carotid IMT and BP decreased similarly with olmesartan and atenolol, but only olmesartan reduced the volume of larger atherosclerotic plaques.

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