Место b-адреноблокаторов в новом пересмотре Европейских рекомендаций по диагностике и лечению артериальной гипертонии 2018 г. при терапии пациентов с коморбидной патологией

В обзоре с позиций новейших Европейских рекомендаций по диагностике и лечению артериальной гипертонии рассматривается роль высокоселективных b-адреноблокаторов и прежде всего эталонного представителя данного класса препаратов бисопролола в схемах антигипертензивной терапии у коморбидных пациентов с артериальной гипертонией. С точки зрения доказательной медицины обсуждаются преимущества применения бисопролола у больных с коморбидной ишемической болезнью сердца, хронической сердечной недостаточностью, фибрилляцией предсердий и патологией аорты. Представлены данные о целесообразности и возможности включения в терапию высокоселективных b-адреноблокаторов у пациентов с хронической обструктивной болезнью легких, периферическим атеросклерозом, сахарным диабетом и сексуальной дисфункцией.

артериальная гипертония, рекомендации, бисопролол, коморбидные заболевания, сердечно-сосудистый риск, прогноз

1. Wang J, Ma J.J, Liu J et al. Prevalence and Risk Factors of Comorbidities among Hypertensive Patients in China. Int J Med Sci 2017; 14 (3): 201-12. DOI: 10.7150/ijms.16974

2. Kraemer H.C. Statistical issues in assessing comorbidity. Stat Med 1995; 14: 721-3.

3. Van den Akker M. Comorbidity or multimorbidity: what’s in a name? A review of the literature. Eur J Gen Pract 1996; 2 (2): 65-70.

4. Лазебник Л.Б. Старение и полиморбидность. Consilium Medicum. 2005; 7 (12): 993-6.

5. Greenfield S, Apolone G, McNeil B.J, Cleary P.D. The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement. Comorbidity and outcomes after hip replacement. Med Care 1993; 31 (2): 141-54.

6. Noh J, Kim H.C, Shin A et al. Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013. Korean Circ J 2016; 46 (5): 672-80. DOI: 10.4070/kcj.2016.46.5.672

7. Williams B, Mancia G, Spiering W et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the ESC and ESH. Eur Heart J 2018; 39 (33): 3021-104. DOI: 10.1093/eurheartj/ehy339

8. 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 ESH and of the ESC. J Hypertens 2013; 31: 1281-357. DOI: 10.1097/01.hjh.0000431740.32696.cc

9. Yusuf S, Hawken S, Ounpuu S et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364 (9438): 937-52. DOI: 10.1016/S0140-6736(04)17018-9

10. Rapsomaniki E, Timmis A, George J et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet 2014; 383 (9932): 1899-911. DOI: 10.1016/S0140-6736(14)60685-1

11. Ettehad D, Emdin C.A, Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387 (10022): 957-67. DOI: 10.1016/S0140-6736(15)01225-8

12. Law M.R, Morris J.K, Wald N.J. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665. DOI: 10.1136/bmj.b1665

13. Клиническая фармакология. Учебник. Под ред. В.Г.Кукеса. 3-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2006.

14. Лукина Ю.В, Марцевич С.Ю. Бисопролол - высокоселективный бета-адреноблокатор с позиции доказательной медицины. Рацион. фармакотерапия в кардиологии. 2010; 6 (1): 103-7.

15. Оганезова Л.Г. Бисопролол - оптимальный бета-адреноблокатор для лечения сердечно-сосудистых заболеваний. Рус. мед. журн. 2012; 11: 560-2.

16. Wellstein A, Palm D, Belz G. Affinity and selectivity of the b-adrenoceptor antagonists in vitro. J Cardiovasc Pharmacol 1985; 8 (Suppl. 2) 11: 36-40. DOI: 10.1097/00005344-198511001-00006

17. De Muinck E.D, Buchner-Moell D, van de Ven L.L.M, Lie K.I; on behalf of the MIRSA Study Group. Comparison of the safety and efficacy of bisoprolol versus atenolol in stable exercise-induced angina pectoris: a Multicenter International Randomized Study of Angina Oectoris (MIRSA). J Cardiovasc Pharmacol 1992; 19: 870-5.

18. Poldermans D, Boersma E, Bax J.J et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341 (24): 1789-94. DOI: 10.1056/NEJM199912093412402

19. Ponikowski P, Voors A.A, Anker S.D et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the ESC Developed with the special contribution of the HFA of the ESC. Eur Heart J 2016; 37 (27): 2129-200. DOI: 10.1093/eurheartj/ehw128

20. CIBIS Investigators and Committees. A randomized trial of beta-blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). CIBIS Investigators and Committees. Circulatio 1994; 90 (4): 1765-73. DOI: 10.1161/01.CIR.90.4.1765

21. CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999; 353 (9146): 9-13. DOI: 10.1016/S0140-6736(98)11181-9

22. Willenheimer R, van Veldhuisen D.J, Silke B et al.; CIBIS III Investigators. Effect on survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence: results of the randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III. Circulation 2005; 112 (16): 2426-35. DOI: 10.1161/CIRCULATIONAHA.105.582320

23. Lip G.Y Atrial Fibrillation in Patients With Hypertension: Trajectories of Risk Factors in Yet Another Manifestation of Hypertensive Target Organ Damage. Hypertension 2016; 68 (3): 544-5. DOI: 10.1161/HYPERTENSIONAHA.116.07901

24. Freedman B, Potpara T.S, Lip G.Y. Stroke prevention in atrial fibrillation. Lancet 2016; 388 (10046): 806-17. DOI: 10.1016/S0140-6736(16)31257-0

25. Marazzi G, Iellamo F, Volterrani M et al. Comparison of effectiveness of carvedilol versus bisoprolol for prevention of postdischarge atrial fibrillation after coronary artery bypass grafting in patients with heart failure. Am J Cardiol 2011; 107 (2): 215-9. DOI: 10.1016/j.amjcard.2010.08.062

26. Negreva M.N, Penev A.P. Effect of selective beta-blockade with bisoprolol in the treatment of recentonset atrial fibrillation. Folia Med (Plovdiv) 2012; 54 (2): 27-31. DOI: 10.2478/v10153-011-0085-7

27. Ishiguro H, Ikeda T, Abe A et al. Antiarrhythmic effect of bisoprolol, a highly selective beta1-blocker, in patients with paroxysmal atrial fibrillation. Int Heart J 2008; 49 (3): 281-93.

28. Farsang C.K, Kiss I, Tykarski A, Narkiewicz K. Treatment of hypertension in patients with chronic obstructive pulmonary disease (COPD). Eur Society Hypertens Sci Newsletter 2016; 17: 62.

29. Rutten F.H, Zuithoff N.P, Hak E et al. Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 2010; 170 (10): 880-7. DOI: 10.1001/archinternmed.2010.112

30. Coiro S, Girerd N, Rossignol P et al. Association of beta-blocker treatment with mortality following myocardial infarction in patients with chronic obstructive pulmonary disease and heart failure or left ventricular dysfunction: a propensity matched-cohort analysis from the High-Risk Myocardial Infarction Database Initiative. Eur J Heart Fail 2017; 19: 271-9. DOI: 10.1002/ejhf.647

31. Напалков Д.А., Панферов А.С. Особенности течения сердечно-сосудистых заболеваний и принципы выбора рациональной антигипертензивной терапии у больных хронической обструктивной болезнью легких. Системные гипертензии. 2013; 3: 77-9.

32. Salpeter S, Ormiston T, Salpeter E. Cardioselective betablocker use in patients with reactive airway disease: a metaanalysis. Ann Intern Med 2002; 137: 715-25.

33. Kazani S, Israel E. Treatment with beta blockers in people with COPD. BMJ 2011; 342: d2655. DOI: 10.1136/bmj.d2655

34. Dorow P, Bethge H, Tönnesmann U. Effects of single oral doses of bisoprolol and atenolol on airway function in nonasthmatic chronic obstructive lung disease and angina pectoris. Eur J Clin Pharmacol 1986; 31 (2): 143-7.

35. Düngen H.D, Apostolovic S, Inkrot S et al.; CIBIS-ELD investigators and Project Multicentre Trials in the Competence Network Heart Failure. Titration to target dose of bisoprolol vs. carvedilol in elderly patients with heart failure: the CIBIS-ELD trial. Eur J Heart Fail 2011; 13 (6): 670-80. DOI: 10.1093/eurjhf/hfr020

36. Кукес В.Г., Остроумова О.Д., Мамаев В.И. и др. Эффективность и безопасность различных бета-блокаторов у пациентов с изолированной систолической гипертонией и сопутствующими сахарным диабетом и обструктивными заболеваниями легких. Терапевтический архив. 2003; 8: 43-7.

37. Aboyans V, Ricco J.B, Bartelink M.E.L et al.; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the ESVS: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the ESO The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the ESC and of the ESVS. Eur Heart J 2018; 39 (9): 763-816. DOI: 10.1093/eurheartj/ehx095

38. Catapano A.L, Graham I, De Backer G et al. ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37 (39): 2999-58. DOI: 10.1093/eurheartj/ehw272

39. Criqui М.Н, Aboyans V. Epidemiology of Peripheral Artery Disease. Circ Res 2015; 116: 1509-26. DOI: 10.1161/CIRCRESAHA.116.303849

40. Hirsch A.T, Criqui M.H, Treat-Jacobson D et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286 (11): 1317-24. DOI: 10.1001/jama.286.11.1317

41. Paravastu S.C, Mendonca D.A, da Silva A. Beta blockers for peripheral arterial disease. Eur J Vasc Endovasc Surg 2009; 38: 66-70. DOI: 10.1016/j.ejvs.2009.02.019

42. Radack K, Deck C. Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. A meta-analysis of randomized controlled trials. Arch Intern Med 1991; 151 (9): 1769-76. DOI: 10.1001/archinte.1991.00400090063012

43. Van de Ven L.L, Van Leeuwen J.T, Smit A.J. The influence of chronic treatment with betablockade and angiotensin converting enzyme inhibition on the peripheral blood flow in hypertensive patients with and without concomitant intermittent claudication. A comparative cross-over trial. Vasa 1994; 23 (4): 357-62.

44. Soga Y, Iida O, Suzuki K et al. Clinical impact of bisoprolol versus carvedilol in patients undergoing femoropopliteal stenting. J Atheroscler Thromb 2014; 21 (7): 691-702. DOI: 10.5551/jat.21121

45. Fogari R, Zoppi A, Tettamanti F et al. b-Blocker effects on plasma lipids in antihypertensive therapy: importance of the duration of treatment and the lipid status before treatment. J Cardiovasc Pharmacol 1990; 16 (Suppl. 5): S76-S80.

46. Wijkman M, Länne T, Engvall J et al. Masked nocturnal hypertension--a novel marker of risk in type 2 diabetes. Diabetologia 2009; 52 (7): 1258-64. DOI: 10.1007/s00125-009-1369-9

47. Pavlyuk E.A, Sirenko Y.N, Rekovets O.L, Savitskiy S. The impact of beta-adrenergic blockers atenolol, carvedilol and bisoprolol on the insulinresistance in patients with arterial hypertension and metabolic syndrome: Abstract P4854. Eur Heart J 2007; 28 (Suppl. 1): 870.

48. Shamloul R, Ghanem H. Erectile dysfunction. Lancet 2013; 381 (9861): 153-65. DOI: 10.1016/S0140-6736(12)60520-0

49. Dong J.Y, Zhang Y.H, Qin L.Q. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol 2011; 58 (13): 1378-85. DOI: 10.1016/j.jacc.2011.06.024

50. Broekman C.P, Haensel S.M, Van de Ven L.L, Slob A.K. Bisoprolol and hypertension: effects on sexual functioning in men. J Sex Marital Ther 1992; 18 (4): 325-31. DOI: 10.1080/00926239208412857

51. Лоран О.Б., Сегал А.С., Верткин А.Л. и др. Клиническая эффективность и влияние b-адреноблокаторов на копулятивную функцию у больных артериальной гипертензией. Кардиология. 2002; 9: 39-42.