Терапия блокаторами рецепторов ангиотензина и кардиоваскулярная протекция. Современная доказательная база и перспективы развития

Цель. Дифференцировать блокаторы рецепторов ангиотензина (БРА) по степени выраженности сосудистых эффектов и влиянию на клинические исходы, регистрируемые в исследованиях кардиопротективного действия этих препаратов.
Источники информации. Поиск информации происходил в период с 01.2003г по 03.2009г с помощью системы MEDLINE и с использованием следующих поисковых терминов: блокада или ингибирование ренин-ангиотензин-альдостероновой системы (РААС); БРА; кардиопротекция; вазопротекция; защита органов-мишеней; кандесартан; эпросартан; ирбесартан; лозартан; олмесартан; телмисартан; валсартан. Поиск клинических исследований в фазах продолжающегося наблюдения либо набора участников выполнялся с помощью сайта Clinicaltrials.gov (07.2008г).
Отбор исследований и обобщение данных. В настоящий обзор вошли соответствующие критериям включения результаты экспериментальных и клинических исследований с сердечно-сосудистыми конечными точками, а также результаты научных обзоров, статистические данные Американской ассоциации кардиологов за 2009г и рекомендации Седьмого доклада Объединенного Национального Комитета по профилактике, диагностике и лечению повышенного артериального давления.
Обобщение данных. БРА различаются по своим плейотропным вазопротективным эффектам и фармакокинетическим свойствам, которые лежат в основе фармакологической защиты в отношении сердечнососудистой заболеваемости и смертности и не зависят от антигипертензивного действия этих препаратов.
Заключение. Постоянно растущая доказательная база свидетельствует об эффективности БРА при артериальной гипертензии, гипертрофии левого желудочка, сердечной недостаточности и после перенесенного инфаркта миокарда. В будущих исследованиях предстоит уточнить, в какой степени эти благоприятные клинические эффекты БРА обусловлены их плейотропным действием, не зависящим от антигипертензивной активности. Для дифференцирования БРА по их клиническим эффектам необходимо выполнение тщательно спланированных исследований сравнительной эффективности отдельных представителей этого класса препаратов. В будущем будут созданы многофункциональные БРА, фармакологическое действие которых не будет ограничиваться блокадой рецепторов ангиотензина I типа (AT1).

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