systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»systhiper-287Research ArticleКАРДИОЛОГИЯCARDIOLOGYКомбинированная фармакотерапия артериальной гипертензии: взгляд через призму клинических рекомендаций 2013 годаCombined pharmacotherapy for arterial hypertension: a view through the 2013 clinical practice guidelinesРодионовА. В.RodionovA. V.noemail@neicon.ruГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава РФRussian Federation20132312202210258Copyright © Родионов А.В., 20222022Родионов А.В.Rodionov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/287

В статье рассматриваются основные изменения в подходах к лечению артериальной гипертензии с позиции клинических рекомендаций по данному заболеванию Европейского общества кардиологов/Европейского общества артериальной гипертензии 2013 г. Основное внимание уделено дифференцированному подходу к комбинированной фармакотерапии, в том числе с применением фиксированной комбинации лерканидипина и эналаприла.

The paper considers major changes in approaches to treating arterial hypertension in the context of the 2013 clinical guidelines on hypertension of the European Society of Cardiology/European Society of Arterial Hypertension. Prominence is given to a differentiated approach to combined pharmacotherapy, including the use of a fixed-dose lercanidipine/enalapril combination.

артериальная гипертензиялечениефиксированная комбинациялерканидипинэналаприлarterial hypertensiontreatmentfixed-dose combinationlercanidipineenalaprilReferencesMancia G, de Backer G, Dominiczak A et al. ESH - ESC Task Force on the Management of Arterial Hypertension. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH - ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007; 25 (9): 1751–62.Mancia G, de Backer G, Dominiczak A et al. ESH - ESC Task Force on the Management of Arterial Hypertension. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH - ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007; 25 (9): 1751–62.Mancia G, Laurent S, Agabiti-Rosei E et al. European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27 (11): 2121–58.Mancia G, Laurent S, Agabiti-Rosei E et al. European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27 (11): 2121–58.Mancia G, Fagard R, Narkiewicz K et al. ESH - ESC Task Force on the Management of Arterial Hypertension. 2013 ESH - ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. Eur Heart J. Doi:10.1093/eurheartj/eht151 (in press).Mancia G, Fagard R, Narkiewicz K et al. ESH - ESC Task Force on the Management of Arterial Hypertension. 2013 ESH - ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. Eur Heart J. Doi:10.1093/eurheartj/eht151 (in press).Materson B.J., Reda D.J., Cushman W.C. et al. Singledrug therapy for hypertension in men. a comparison of six antihypertensive agents with placebo. N Engl J Med 1993; 328: 9–14.Materson B.J., Reda D.J., Cushman W.C. et al. Singledrug therapy for hypertension in men. a comparison of six antihypertensive agents with placebo. N Engl J Med 1993; 328: 9–14.Wald D.S., Law M, Morris J.K. et al. Combination therapy versus monotherapy in reducing blood pressure: meta - analysis on 11,000 participants from 42 trials. Am J Med 2009; 122 (3): 290–300.Wald D.S., Law M, Morris J.K. et al. Combination therapy versus monotherapy in reducing blood pressure: meta - analysis on 11,000 participants from 42 trials. Am J Med 2009; 122 (3): 290–300.ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370 (9590): 829–40.ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370 (9590): 829–40.Liu L, Zhang Y, Liu G et al. FEVER Study Group. The Felodipine Event Reduction (FEVER) Study: a randomized long - term placebo - controlled trial in Chinese hypertensive patients. J Hypertens 2005; 23 (12): 2157–72.Liu L, Zhang Y, Liu G et al. FEVER Study Group. The Felodipine Event Reduction (FEVER) Study: a randomized long - term placebo - controlled trial in Chinese hypertensive patients. J Hypertens 2005; 23 (12): 2157–72.Jamerson K, Weber M.A., Bakris G.L. et al. ACCOMPLISH Trial Investigators.Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359 (23): 2417–28.Jamerson K, Weber M.A., Bakris G.L. et al. ACCOMPLISH Trial Investigators.Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359 (23): 2417–28.Mancia G, Grassi G, Zanchetti A. New - onset diabetes and antihypertensive drugs. J Hypertens 2006; 24 (1): 3–10.Mancia G, Grassi G, Zanchetti A. New - onset diabetes and antihypertensive drugs. J Hypertens 2006; 24 (1): 3–10.Yusuf S, Teo K.K., Pogue J et al. ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358 (15): 1547–59.Yusuf S, Teo K.K., Pogue J et al. ONTARGET Investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358 (15): 1547–59.Parving H.H., Brenner B.M., Mc Murray J.J. ALTITUDE Investigators. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012; 367 (23): 2204–13.Parving H.H., Brenner B.M., Mc Murray J.J. ALTITUDE Investigators. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012; 367 (23): 2204–13.Coleman C.I., Roberts M.S., Sobieraj D.M. et al. Effect of dosing frequency on chronic cardiovascular disease medication adherence. Curr Med Res Opin 2012.Coleman C.I., Roberts M.S., Sobieraj D.M. et al. Effect of dosing frequency on chronic cardiovascular disease medication adherence. Curr Med Res Opin 2012.Gupta A.K., Arshad S, Poulter N.R. Compliance, safety, and effectiveness of fixed - dose combinations of antihypertensive agents: a meta - analysis. Hypertension 2010; 55 (2): 399–407.Gupta A.K., Arshad S, Poulter N.R. Compliance, safety, and effectiveness of fixed - dose combinations of antihypertensive agents: a meta - analysis. Hypertension 2010; 55 (2): 399–407.Bang L.M., Chapman T.M., Goa K.L. Lercanidipine: a review of its efficacy in the management of hypertension. Drugs 2003; 63: 2449–72.Bang L.M., Chapman T.M., Goa K.L. Lercanidipine: a review of its efficacy in the management of hypertension. Drugs 2003; 63: 2449–72.Meredith P.A. Lercanidipine: a novel lipophilic dihydropyridine calcium antagonist with long duration of action and high vascular selectivity. Expert Opin Investig Drugs 1999; 8: 1043–62.Meredith P.A. Lercanidipine: a novel lipophilic dihydropyridine calcium antagonist with long duration of action and high vascular selectivity. Expert Opin Investig Drugs 1999; 8: 1043–62.Epstein M. Lercanidipine: a novel dihydropyridine calcium - channel blocker. Heart Dis 2001; 3: 398–407.Epstein M. Lercanidipine: a novel dihydropyridine calcium - channel blocker. Heart Dis 2001; 3: 398–407.Barrios V, Navarro A, Esteras A et al. Antihypertensive efficacy and tolerability of lercanidipine in daily clinical practice. The ELYPSE Study. Blood Press 2002; 11: 95–100.Barrios V, Navarro A, Esteras A et al. Antihypertensive efficacy and tolerability of lercanidipine in daily clinical practice. The ELYPSE Study. Blood Press 2002; 11: 95–100.Barrios V, Escobar C, Navarro A et al. Lercanidipine is an effective and well tolerated antihypertensive drug regardless the cardiovascular risk profile: The LAURA study. Int J Clin Pract 2006; 60: 1364–70.Barrios V, Escobar C, Navarro A et al. Lercanidipine is an effective and well tolerated antihypertensive drug regardless the cardiovascular risk profile: The LAURA study. Int J Clin Pract 2006; 60: 1364–70.Agrawal R, Marx A, Haller H. Efficacy and safety of lercanidipine versus hydrochlorothiazide as add - on to enalapril in diabetic populations with uncontrolled hypertension. J Hypertens 2006; 24: 185–92.Agrawal R, Marx A, Haller H. Efficacy and safety of lercanidipine versus hydrochlorothiazide as add - on to enalapril in diabetic populations with uncontrolled hypertension. J Hypertens 2006; 24: 185–92.Puig J.G., Calvo C, Luurila O et al. Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebo - controlled, randomized, crossover study with four ABPM. J Hum Hypertens 2007; 21: 917–24.Puig J.G., Calvo C, Luurila O et al. Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebo - controlled, randomized, crossover study with four ABPM. J Hum Hypertens 2007; 21: 917–24.Menne J, Haller H. Fixed - dose lercanidipine/enalapril for hypertension. Drugs Today (Barc) 2008; 44 (4): 261–70.Menne J, Haller H. Fixed - dose lercanidipine/enalapril for hypertension. Drugs Today (Barc) 2008; 44 (4): 261–70.Borghi C, Cicero A.F. Rationale for the use of a fixed - dose combination in the management of hypertension: efficacy and tolerability of lercanidipine/enalapril. Clin Drug Investig 2010; 30 (12): 843–54.Borghi C, Cicero A.F. Rationale for the use of a fixed - dose combination in the management of hypertension: efficacy and tolerability of lercanidipine/enalapril. Clin Drug Investig 2010; 30 (12): 843–54.Tocci G, Palano F, Pagannone E et al. Fixed - combination therapies in hypertension management: focus on enalapril/lercanidipine. Expert Rev Cardiovasc Ther 2009; 7 (2): 115–23.Tocci G, Palano F, Pagannone E et al. Fixed - combination therapies in hypertension management: focus on enalapril/lercanidipine. Expert Rev Cardiovasc Ther 2009; 7 (2): 115–23.Rump L.C. Efficacy and tolerability of the fixed lercanidipine - enalapril combination in the treatment of patients with essential hypertension. Arzneimittelforschung 2010; 60 (3): 124–30.Rump L.C. Efficacy and tolerability of the fixed lercanidipine - enalapril combination in the treatment of patients with essential hypertension. Arzneimittelforschung 2010; 60 (3): 124–30.Scholze J, Bramlage P, Trenkwalder P, Kreutz R. Efficacy and safety of a fixed - dose combination of lercanidipine and enalapril in daily practice. A comparison of office, self - measured and ambulatory blood pressure. Expert Opin Pharmacother 2011; 12 (18): 2771–9.Scholze J, Bramlage P, Trenkwalder P, Kreutz R. Efficacy and safety of a fixed - dose combination of lercanidipine and enalapril in daily practice. A comparison of office, self - measured and ambulatory blood pressure. Expert Opin Pharmacother 2011; 12 (18): 2771–9.Cicero A.F., Gerocarni B, Rosticci M, Borghi C. Blood pressure and metabolic effect of a combination of lercanidipine with different antihypertensive drugs in clinical practice. Clin Exp Hypertens 2012; 34 (2): 113–7.Cicero A.F., Gerocarni B, Rosticci M, Borghi C. Blood pressure and metabolic effect of a combination of lercanidipine with different antihypertensive drugs in clinical practice. Clin Exp Hypertens 2012; 34 (2): 113–7.Robles N.R. Calcium antagonists and renal failure: new properties for new generations. Med Hypotheses Res 2006; 3 (2): 709–25.Robles N.R. Calcium antagonists and renal failure: new properties for new generations. Med Hypotheses Res 2006; 3 (2): 709–25.Carmines P.K., Navar L.G. Disparate effects of Ca channel blockers on afferent and efferent arteriolar responses to ANG II. Am J Physiol 1989; 256: F1015–F1020.Carmines P.K., Navar L.G. Disparate effects of Ca channel blockers on afferent and efferent arteriolar responses to ANG II. Am J Physiol 1989; 256: F1015–F1020.Dworkin L.D. Effects of calcium channel blockers on glomerular injury on experimental glomerular injury. J Am Soc Nephrol 1990; 1: S21–S27.Dworkin L.D. Effects of calcium channel blockers on glomerular injury on experimental glomerular injury. J Am Soc Nephrol 1990; 1: S21–S27.Praga M, Fernandez Andrade C, Luño J et al. Antiproteinuric efficacy of losartan in comparison with amlodipine in non - diabetic proteinuric renal diseases: a double - blind, randomised clinical trial. Nephrol Dial Transplant 2003; 18: 1806–13.Praga M, Fernandez Andrade C, Luño J et al. Antiproteinuric efficacy of losartan in comparison with amlodipine in non - diabetic proteinuric renal diseases: a double - blind, randomised clinical trial. Nephrol Dial Transplant 2003; 18: 1806–13.Crepaldi G, Carta Q, Deferrari G et al. Effects of lisinopril and nifedipine on the progression to overt albuminuria in IDDM patients with incipient nephropathy and normal blood pressure. The Italian Microalbuminuria Study Group in IDDM. Diabetes Care 1998; 21: 104–10.Crepaldi G, Carta Q, Deferrari G et al. Effects of lisinopril and nifedipine on the progression to overt albuminuria in IDDM patients with incipient nephropathy and normal blood pressure. The Italian Microalbuminuria Study Group in IDDM. Diabetes Care 1998; 21: 104–10.Herlitz H, Harris K, Risler T et al. The effect of an ACE inhibitor and a calcium antagonist in the progression of renal disease: The Nephros Study. Nephrol Dial Transplant 2001; 16: 2158–65.Herlitz H, Harris K, Risler T et al. The effect of an ACE inhibitor and a calcium antagonist in the progression of renal disease: The Nephros Study. Nephrol Dial Transplant 2001; 16: 2158–65.Dalla Vestra M et al. Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive type 2 diabetic patients with microalbuminuria: DIAL Study (Diabetes, Ipertensione, Albuminuria, Lercanidipina). Diab Nutr Metab 2004; 17: 259–66.Dalla Vestra M et al. Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive type 2 diabetic patients with microalbuminuria: DIAL Study (Diabetes, Ipertensione, Albuminuria, Lercanidipina). Diab Nutr Metab 2004; 17: 259–66.Robles N.R., Romero B, de Vinuesa E.G. et al. Treatment of proteinuria with lercanidipine associated with renin - angiotensin axis - blocking drugs. Ren Fail 2010; 32: 192–7.Robles N.R., Romero B, de Vinuesa E.G. et al. Treatment of proteinuria with lercanidipine associated with renin - angiotensin axis - blocking drugs. Ren Fail 2010; 32: 192–7.

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