systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»systhiper-447Research ArticleОБЗОРЫ / REVIEWSСовременный взгляд на место b-адреноблокаторов в лечении сердечно - сосудистых заболеваний: выбор препарата внутри класса имеет определяющее значениеA modern view of the place of b-blockers in the treatmentof cardiovascular disease: the choice of drug within a class is crucialОстроумоваО. Д.OstroumovaO. D.ostroumova.olga@mail.ruФоминаВ. М.FominaV. M.noemail@neicon.ruСмолярчукЕ. А.SmolyarchukE. A.smolyarchuk@mail.ruГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава России; ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава РоссииРоссияA.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian Federation; I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian FederationRussian FederationГБОУ ВПО Московский государственный медико-стоматологический университет им. А.И.Евдокимова Минздрава РоссииРоссияA.I.Evdokimov Moscow State Medical and Dental University of the Ministry of Health of the Russian FederationRussian FederationГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава РоссииРоссияI.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian FederationRussian Federation2015231220221246974Copyright © Остроумова О.Д., Фомина В.М., Смолярчук Е.А., 20222022Остроумова О.Д., Фомина В.М., Смолярчук Е.А.Ostroumova O.D., Fomina V.M., Smolyarchuk E.A.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/447

В статье рассмотрены вопросы применения b-адреноблокаторов (b-АБ) для лечения артериальной гипертензии, ишемической болезни сердца, хронической сердечной недостаточности. Приведены данные из современных российских и европейских рекомендаций о месте b-АБ при лечении сердечно-сосудистых заболеваний. Подробно проанализирован выбор b-АБ внутри класса с позиций особенностей фармакокинетики, селективности, изученности в клинических исследованиях. Приведены данные об эффективности и безопасности применения метопролола сукцината для лечения артериальной гипертензии, ишемической болезни сердца, хронической сердечной недостаточности.

In the article discusses questions of application of b-blockers (b-AB) for the treatment of arterial hypertension, coronary heart disease, chronic heart failure. The data from modern Russian and European recommendations about the place of b-AB in the treatment of cardiovascular diseases. Analyzed in detail the selection of b-AB inside the class from the standpoint of pharmacokinetics, selectivity, study in clinical studies. Data about efficiency and safety of application of metoprolol succinate for the treatment of arterial hypertension, coronary heart disease, chronic heart failure.

артериальная гипертензияишемическая болезнь сердцахроническая сердечная недостаточностьметопролола сукцинатb-адреноблокаторыarterial hypertensionischemic heart diseasechronic heart failureb-blockersmetoprolol succinateReferencesАгеев Ф.Т., Овчинников А.Г. Бета - адреноблокаторы. В кн.: Справочник по медикаментозному лечению сердечно - сосудистых заболеваний. Под ред. Е.И.Чазова. М.: Практика, 2015; с. 125-35.Агеев Ф.Т., Овчинников А.Г. Бета - адреноблокаторы. В кн.: Справочник по медикаментозному лечению сердечно - сосудистых заболеваний. Под ред. Е.И.Чазова. М.: Практика, 2015; с. 125-35.Bradley H.A, Wiyonge C.S, Volmink V.A et al. How strong is the evidence for use of beta - blockers as first line therapy for hypertension? J Hypertens 2006; 24: 2131-41.Bradley H.A, Wiyonge C.S, Volmink V.A et al. How strong is the evidence for use of beta - blockers as first line therapy for hypertension? J Hypertens 2006; 24: 2131-41.Wiyonge C.S, Bradley H.A, Volmink J et al. Cochrane Database Syst Rev 2012; Nov 14, 11: CD002003.doi.Wiyonge C.S, Bradley H.A, Volmink J et al. Cochrane Database Syst Rev 2012; Nov 14, 11: CD002003.doi.Law M.R, Morris J.K, Wald N.J. Use of blood pressure lowering drugs in the preventionof cardiovascular disease: meta - analysis of 147 randomised trials in the context ofexpectations from prospective epidemiological studies. BMJ 2009; 338: b1665.Law M.R, Morris J.K, Wald N.J. Use of blood pressure lowering drugs in the preventionof cardiovascular disease: meta - analysis of 147 randomised trials in the context ofexpectations from prospective epidemiological studies. BMJ 2009; 338: b1665.Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blo - odpressure - lowering regimens on major cardiovascular events in individuals with and withoutdiabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 2005; 165: 1410-9.Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blo - odpressure - lowering regimens on major cardiovascular events in individuals with and withoutdiabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 2005; 165: 1410-9.Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blo - odpressure - lowering regimens on major cardiovascular events: results of prospectivelydesignedoverviews ofrandomised trials. Lancet 2003; 362: 1527-35.Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blo - odpressure - lowering regimens on major cardiovascular events: results of prospectivelydesignedoverviews ofrandomised trials. Lancet 2003; 362: 1527-35.Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertans 2013; 31: 1281-357.Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertans 2013; 31: 1281-357.Клиническая фармакология. 4-е изд. Под ред. В.Г.Кукеса. М.: ГЭОТАР-Медиа, 2008; с. 392-5.Клиническая фармакология. 4-е изд. Под ред. В.Г.Кукеса. М.: ГЭОТАР-Медиа, 2008; с. 392-5.MERIT-HF Study Group. Effects of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomized International Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353 (9169): 2001-7.MERIT-HF Study Group. Effects of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomized International Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353 (9169): 2001-7.MERIT-HF Study Group. Effect of controlled - release metoprolol on total mortality, hospitalizations, and well - being in patients with heart failure: Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure. MERIT-HF Study Group. JAMA 2000; 283: 1295-02.MERIT-HF Study Group. Effect of controlled - release metoprolol on total mortality, hospitalizations, and well - being in patients with heart failure: Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure. MERIT-HF Study Group. JAMA 2000; 283: 1295-02.Falkner B, Kushner H. Treatment With Metoprolol Succinate, a Selective Beta Adrenergic Blocker, Lowers Blood Pressure Without Altering Insulin Sensitivity in Diabetic Patients. J ClinHypertens 2008; 10: 51-7.Falkner B, Kushner H. Treatment With Metoprolol Succinate, a Selective Beta Adrenergic Blocker, Lowers Blood Pressure Without Altering Insulin Sensitivity in Diabetic Patients. J ClinHypertens 2008; 10: 51-7.Camsari A, Arikan S, Avan C et al. Metoprolol, a beta-1 selective blocker, can be used safely in coronary artery disease patients with chronic obstructive pulmonary disease. Heart Vessels 2003; 18: 188-92.Camsari A, Arikan S, Avan C et al. Metoprolol, a beta-1 selective blocker, can be used safely in coronary artery disease patients with chronic obstructive pulmonary disease. Heart Vessels 2003; 18: 188-92.Franzen D, Metha A, Seifert N et al. Effects of beta - blockers on sexual performance in men with coronary heart disease. A prospective, randomized and double blinded study. Int J Impot Res 2001; 13: 348-351.Franzen D, Metha A, Seifert N et al. Effects of beta - blockers on sexual performance in men with coronary heart disease. A prospective, randomized and double blinded study. Int J Impot Res 2001; 13: 348-351.Elliott W, Meyer P.M. Incident diabetes in clinical trials of antihypertensive drugs: a network meta - analysis. Lancet 2007; 369: 201-7.Elliott W, Meyer P.M. Incident diabetes in clinical trials of antihypertensive drugs: a network meta - analysis. Lancet 2007; 369: 201-7.Чазова И.Е., Ратова Л.Г., Бойцов С.А., Небиеридзе Д.В. Диагностика и лечение артериальной гипертензии. Системные гипертензии. 2010; 7 (3): 5-26.Чазова И.Е., Ратова Л.Г., Бойцов С.А., Небиеридзе Д.В. Диагностика и лечение артериальной гипертензии. Системные гипертензии. 2010; 7 (3): 5-26.Hedblad B, Wikstrand J, Jabzon L et al. Low dose metoprolol CR/XL and fluvastatin slow progression of carotid intima - media thickness: main resultsfrom the Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001; 103: 1721-6.Hedblad B, Wikstrand J, Jabzon L et al. Low dose metoprolol CR/XL and fluvastatin slow progression of carotid intima - media thickness: main resultsfrom the Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001; 103: 1721-6.Wiklund O, Hulthe J, Wikstrand J et al. Effect of controlled release/extended release metoprolol on carotid intima - media thickness in patients with hypercholesterolemia: a 3-year randomized study. Stroke 2002; 33 (2): 572-7.Wiklund O, Hulthe J, Wikstrand J et al. Effect of controlled release/extended release metoprolol on carotid intima - media thickness in patients with hypercholesterolemia: a 3-year randomized study. Stroke 2002; 33 (2): 572-7.Rutten F.H, Zuithoff N.P, Halk F et al. Beta-Blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 2010; 170: 880-7.Rutten F.H, Zuithoff N.P, Halk F et al. Beta-Blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 2010; 170: 880-7.Sandberg A, Blomqvist I, Jonsson U.E, Lundborg P. Pharmacokinetic and pharmacodynamic properties of a new controlled - release formulation of metoprolol: A comparison with conventional tablets. Eur J Clin Pharmacol 1988; 33 (Suppl.): S9.Sandberg A, Blomqvist I, Jonsson U.E, Lundborg P. Pharmacokinetic and pharmacodynamic properties of a new controlled - release formulation of metoprolol: A comparison with conventional tablets. Eur J Clin Pharmacol 1988; 33 (Suppl.): S9.Oosterhuis B, Jonkman J, Zuiderwijk P, Sollie F. A pharmacokineticand pharmacodynamic comparison of metoprolol CR/ZOK with aconventional slow release preparation. J Clin Pharmacol 1990; 30: S33-S38.Oosterhuis B, Jonkman J, Zuiderwijk P, Sollie F. A pharmacokineticand pharmacodynamic comparison of metoprolol CR/ZOK with aconventional slow release preparation. J Clin Pharmacol 1990; 30: S33-S38.Sandberg A, Abrahamsson B, Regardh C-G et al. Pharmacokinetic and biopharmaceutic aspects of once daily treatment with metoprolol CR/ZOK: a review article. J Clin Pharmacol 1990; 30: S2-S16.Sandberg A, Abrahamsson B, Regardh C-G et al. Pharmacokinetic and biopharmaceutic aspects of once daily treatment with metoprolol CR/ZOK: a review article. J Clin Pharmacol 1990; 30: S2-S16.Lee Y-T, Liau C-S, Wong E.C.K et al. Pharmacokinetic and pharmacodynamic comparison of conventional and controlled release formulation of metoprolol in healthy Chinese subjects. Cardiovasc Drugs Ther 1989; 3 (4): 529-33.Lee Y-T, Liau C-S, Wong E.C.K et al. Pharmacokinetic and pharmacodynamic comparison of conventional and controlled release formulation of metoprolol in healthy Chinese subjects. Cardiovasc Drugs Ther 1989; 3 (4): 529-33.Lucker P, Moore G, Wiselgren I et al. Pharmacokinetic and pharmacodynamic comparison of metoprolol CR/ZOK once daily with conventional tablets once daily and in divided doses. J Clin Pharmacol 1990; 30 (Suppl.): S17-S27.Lucker P, Moore G, Wiselgren I et al. Pharmacokinetic and pharmacodynamic comparison of metoprolol CR/ZOK once daily with conventional tablets once daily and in divided doses. J Clin Pharmacol 1990; 30 (Suppl.): S17-S27.Houtzagers J.J, Smilde J.G, Creytens G, Westergren G. Efficacy and tolerability of a new controlled - release formulation of metoprolol: a comparison with conventional metoprolol tablets in mild to moderate hypertension. Eur J Clin Pharmacol 1988; 33 (Suppl.): S39-44.Houtzagers J.J, Smilde J.G, Creytens G, Westergren G. Efficacy and tolerability of a new controlled - release formulation of metoprolol: a comparison with conventional metoprolol tablets in mild to moderate hypertension. Eur J Clin Pharmacol 1988; 33 (Suppl.): S39-44.Shkolnikov V, Mc Kee M, Leon D.A. Changes in life expectancy in Russia in the mid - 1990s. Lancet 2001; 357: 917-21.Shkolnikov V, Mc Kee M, Leon D.A. Changes in life expectancy in Russia in the mid - 1990s. Lancet 2001; 357: 917-21.Шальнова С.А., Деев А.Д., Оганов Р.Г. Факторы, влияющие на смертность от сердечно - сосудистых заболеваний в российской популяции. Кардиоваскулярная терапия и профилактика. 2006; 2: 73-7.Шальнова С.А., Деев А.Д., Оганов Р.Г. Факторы, влияющие на смертность от сердечно - сосудистых заболеваний в российской популяции. Кардиоваскулярная терапия и профилактика. 2006; 2: 73-7.Bhatt D.L, Steg P.G, Ohman E.M et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180-9.Bhatt D.L, Steg P.G, Ohman E.M et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180-9.Fihn S.D, Gardin J.M, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for thediagnosis and management of patients with stable ischemic heart disease: a report ofthe American College of Cardiology Foundation/American Heart Association TaskForce on, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012; 60: e44-64.Fihn S.D, Gardin J.M, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for thediagnosis and management of patients with stable ischemic heart disease: a report ofthe American College of Cardiology Foundation/American Heart Association TaskForce on, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012; 60: e44-64.Montalescot G, Sechtem U, Achenbach S et al. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J doi:10.1093/eurheartj/ent296.Montalescot G, Sechtem U, Achenbach S et al. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J doi:10.1093/eurheartj/ent296.Egstrup K, Gundersen T, Harkonen R et al. The antianginal efficacy and tolerability of controlled - release metoprolol once daily: a comparison with conventional metoprolol tablets twice daily. Eur J Clin Pharmacol 1988; 33 (Suppl.): S45-9.Egstrup K, Gundersen T, Harkonen R et al. The antianginal efficacy and tolerability of controlled - release metoprolol once daily: a comparison with conventional metoprolol tablets twice daily. Eur J Clin Pharmacol 1988; 33 (Suppl.): S45-9.Шпектор А.В., Васильева Е.Ю. Современные подходы к вторичной профилактике острого инфаркта миокарда. Креативная кардиология. 2014; 2: 71-80.Шпектор А.В., Васильева Е.Ю. Современные подходы к вторичной профилактике острого инфаркта миокарда. Креативная кардиология. 2014; 2: 71-80.Кириченко А.А. Ишемическая болезнь сердца и контроль частоты сердечных сокращений. Сonsilium Medicum. 2015; 17 (5): 23-5.Кириченко А.А. Ишемическая болезнь сердца и контроль частоты сердечных сокращений. Сonsilium Medicum. 2015; 17 (5): 23-5.Mc Murray J.J.V, Adamopoulos S, Anker S.D et al. ESC Guidelines for diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2012; 33: 1787-847.Mc Murray J.J.V, Adamopoulos S, Anker S.D et al. ESC Guidelines for diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2012; 33: 1787-847.Cohn J.N, Levine T.B, Olivari M.T et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984; 311 (13): 819-23.Cohn J.N, Levine T.B, Olivari M.T et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984; 311 (13): 819-23.Francis G.S, Benedict C, Johnstone D.E et al. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD). Circulation 1990; 82 (5): 1724-9.Francis G.S, Benedict C, Johnstone D.E et al. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD). Circulation 1990; 82 (5): 1724-9.Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. Хроническая сердечная недостаточность. Избранные лекции по кардиологии. М.: ГЭОТАР-Медиа, 2006.Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. Хроническая сердечная недостаточность. Избранные лекции по кардиологии. М.: ГЭОТАР-Медиа, 2006.Беленков Ю.Н., Мареев В.Ю., Скворцов А.А. и др. Клинико - гемодинамические и нейрогуморальные эффекты длительной терапии бета - адреноблокатором бисопрололом больных с тяжелой хронической сердечной недостаточностью. Кардиология. 2003; 43 (10): 11-22.Беленков Ю.Н., Мареев В.Ю., Скворцов А.А. и др. Клинико - гемодинамические и нейрогуморальные эффекты длительной терапии бета - адреноблокатором бисопрололом больных с тяжелой хронической сердечной недостаточностью. Кардиология. 2003; 43 (10): 11-22.Randomised, placebo - controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease. Australia/New Zealand Heart Failure Research Collaborative Group. Lancet 1997; 349 (9049): 375-80.Randomised, placebo - controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease. Australia/New Zealand Heart Failure Research Collaborative Group. Lancet 1997; 349 (9049): 375-80.CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomized trial. Lancet 1999; 353 (9146): 9-13.CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomized trial. Lancet 1999; 353 (9146): 9-13.Wikstrand J, Hjalmarson A, Waagstein F et al. Dose of metoprolol CR/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR/XL randomized intervention trial in chronic heart failure (MERIT-HF). J Am Coll Cardiol 2002; 40 (3): 491-8.Wikstrand J, Hjalmarson A, Waagstein F et al. Dose of metoprolol CR/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR/XL randomized intervention trial in chronic heart failure (MERIT-HF). J Am Coll Cardiol 2002; 40 (3): 491-8.

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