systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2023-4-19-29systhiper-799Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВозможности применения азилсартана медоксомила у больных сахарным диабетом 2 типа в реальной клинической практикеAntihypertensive efficacy and safety of azilsartan medoxomil in patients with diabetes mellitus in real clinical practice. According to the CONSTANT studyhttps://orcid.org/0000-0001-7895-9068ЖернаковаЮ. В.ZhernakovaJu. V.

Жернакова Юлия Валерьевна - д.м.н., профессор, ученый секретарь НИИ клинической кардиологии имени А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России; профессор кафедры кардиологии, РНИМУ им. Н.И. Пирогова.

Ул. Академика Чазова, д. 15 А, Москва 121552

Juliya V. Zhernakova - Dr. of Sci. (Med.), A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of Cardiology; Professor of the Department of Cardiology, N.I. Pirogov RNRMU.

St. Academician Chazova, 15 a, Moscow 121552

juli001@mail.ruhttps://orcid.org/0000-0002-9822-4357ЧазоваИ. Е.ChazovaI. E.

Чазова Ирина Евгеньевна - д.м.н., профессор, академик РАН, зам. ген. директора по научно-экспертной работе, руководитель отдела системных гипертензий, НИИ клинической кардиологии им. А.Л. Мясникова, ФГБУ «НМИЦК им. ак. Е.И. Чазова» Минздрава России.

Ул. Академика Чазова, д. 15 А, Москва 121552, тел.: 8 (495) 415-52-05

Irina E. Chazova - Dr. of Sci. (Med.), Prof., Acad. of RAS, Deputy General Director for Scientific and Expert Work, Head of Hypertension Department, A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov NMRCC.

St. Academician Chazova, 15 a, Moscow 121552, tel.: 8 (495) 415-52-05

c34h@yandex.ruНаучно-исследовательский институт клинической кардиологии им. А.Л. Мясникова, Федеральное бюджетное государственное учреждение «Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of CardiologyRussian Federation2023281220232041929Copyright © Жернакова Ю.В., Чазова И.Е., 20232023Жернакова Ю.В., Чазова И.Е.Zhernakova J.V., Chazova I.E.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/799Актуальность

Актуальность. Ожирение и ассоциированные с ним заболевания являются наиболее частыми коморбидными состояниями у больных артериальной гипертонией (АГ). Сочетание АГ и сахарного диабета 2 типа (СД 2 тип) значимо усугубляет сердечно-сосудистый риск у этой категории больных. Контроль АД – один из ключевых компонентов многофакторного подхода к снижению риска осложнений СД 2 типа. Применение препаратов, обладающих выраженными антигипертензивными свойствами и одновременно способностью улучшать метаболические параметры, должно быть приоритетом у данной категории больных. Оценка эффективности и безопасности азилсартана медоксомила, последней молекулы из класса БРА, у больных АГ с СД 2 типа является актуальной задачей.

Цель исследования

Цель исследования: оценка антигипертензивной эффективности и безопасности препарата азилсартана медоксомила у больных с АГ и СД 2 типа с избыточной массой тела или ожирением.

Материалы и методы

Материалы и методы. 235 пациентов с АГ и СД 2 типа с избыточной массой тела или ожирением, включенных в международное многоцентровое наблюдательное неинтервенционное проспективное исследование CONSTANT с применением азилсартана медоксомила, в соответствии с утвержденной инструкцией по использованию препарата. Период наблюдения – 6 мес.

Результаты

Результаты. Динамика САД к 4 визиту (6 месяцев) составила 29,7±14,5 мм рт. ст., ДАД – 13,36±10,9 мм рт. ст. (р≤0,001). В целом по группе целевые значения АД были достигнуты у 211 (89.41%) пациентов c СД, включенных в исследование. Ответ на терапию (снижение САД минимум на 20 мм рт. ст., ДАД – на 10 мм рт. ст.) был получен у 177 (75,0%) больных. У больных АГ и СД на фоне применения азилсартана медоксомила статистически значимо снизился уровень гликированного гемоглобина (p<0,001) и тощаковой глюкозы (p<0,001). Наблюдалось снижение общего холестерина, триглицеридов и ЛПНП, в том числе у больных СД, не принимающих статины (p<0,001). В целом по группе наблюдалось уменьшение окружности талии (p<0,005).

Заключение

Заключение. Азилсартана медоксомил в реальной клинической практике показал себя высокоэффективным антигипертензивным препаратом у больных АГ с СД. Возможность препарата, в том числе в комбинации с другими препаратами, улучшать метаболический профиль, уменьшать объем жировой ткани делает его приоритетным препаратом выбора у пациентов с АГ, ожирением и СД 2 типа.

Background

Background. Obesity and associated diseases are the most common comorbidities in patients with arterial hypertension (AH). The combination of AH and type 2 diabetes mellitus (DM2) significantly exacerbates the cardiovascular risk in this patients. BP control is one of the key components of the multivariate approach to reducing the risk of DM 2 complications. The use of drugs with pronounced antihypertensive properties and at the same time the ability to improve metabolic parameters should be a priority in this category of patients. Assessing the efficacy and safety of azilsartan medoxomil, the last molecule from the ARB class in patients with AH and DM 2 is an urgent task.

Purpose

Purpose. Evaluation of antihypertensive efficacy and safety of azilsartan medoxomil in patients with AH and DM 2 and overweight or obesity.

Materials and methods

Materials and methods. 235 overweight or obese patients with AH and DM2 enrolled in the international multicenter observational non-interventional prospective study CONSTANT with azilsartan medoxomil according to the approved label. The observation period is 6 months.

Results

Results. The dynamics of SBP by visit 4 (6 months) was 29,7±14,5 mmHg, DBP - 13,36±10,9 mmHg (r≤0,001). Overall, the group achieved BP targets in 211 (89.41%) DM patients enrolled in the study. Response to therapy (reduction in SBP by at least 20 mmHg, DBP of 10 mm Hg) was obtained in 177 (75.0%) patients. Glycated hemoglobin (p<0.001) and fasting glucose (p<0.001) significantly decreased in patients with AH and DM. A decrease in total cholesterol, triglycerides, and LDL was observed, including in DM patients not taking statins (p<0.001). Overall, a decrease in waist circumference was observed across the group (p<0.005).

Conclusion

Conclusion. Azilsartan medoxomil in real clinical practice proved to be a highly effective antihypertensive drug in patients with AH and DM. The ability of the drug, including in combination with other drugs, to improve the metabolic profile, reduce the volume of adipose tissue makes it a priority drug of choice in patients with AH, obesity and type 2 DM.

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