Терапия бета-адреноблокатором небивололом и профилактика острых ишемических осложнений у пожилых пациентов с сердечной недостаточностью

Цель. В дополнительном анализе результатов исследования SENIORS изучали, обладает ли терапия небивололом дополнительными благоприятными эффектами при сердечной недостаточности (СН). В частности, анализ должен был ответить на вопрос, способна ли терапия небивололом снизить частоту сердечных ишемических осложнений у пациентов с СН ишемического генеза.
Материал и методы. В многоцентровом, двойном слепом, рандомизированном, плацебо-контролируемом исследовании SENIORS участвовали 2128 пожилых пациентов в возрасте ≥ 70 лет с СН. У большинства участников исследования SENIORS (68,2 %) СН была осложнением ишемической болезни сердца (ИБС). Группы плацебо и небиволола состояли из 717 и 735 больных, соответственно. Основной комбинированной конечной точкой являлась частота сердечных ишемических осложнений: смерть либо госпитализация по поводу инфаркта миокарда и нестабильной стенокардии, внезапная сердечная смерть за 2 года наблюдения. Результаты. Терапия небивололом ассоциировалась со снижением риска ишемических осложнений на одну треть. Частота комбинированной конечной точки в группе плацебо составила 15,9 % vs 10,7 % в группе небиволола (р=0,008). Этот благоприятный эффект не зависел от возраста и пола пациентов, а также от значений фракции выброса. В подгруппе пациентов с СН неишемической этиологии отсутствовали различия в частоте комбинированной конечной точки между группами плацебо и небиволола.
Заключение. Небиволол эффективно снижал частоту сердечных ишемических осложнений у пациентов с СН ишемического генеза. Профилактика ишемических осложнений может являться дополнительным благоприятным эффектом β-адреноблокады у больных с СН и ИБС.

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