arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2009-15-4-424-430arthyper-1406Research ArticleОБЗОРREVIEWКомбинированная антигипертензивная терапия - современный взгляд на проблемуCombination therapy in hypertensionБарановаЕ. И.eibaranova@yahoo.comГОУ ВПО "Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова"Russian Federation200928082009154424430Copyright © Баранова Е.И., 20092009Баранова Е.И.Баранова Е.И.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1406

Статья посвящена роли комбинированной антигипертензивной терапии в лечении пациентов с артериальной гипертензией. Рассмотрены преимущества комбинированной терапии, в том числе фиксированных комбинаций препаратов. В современных Европейских и Национальных рекомендациях по лечению больных артериальной гипертензией комбинированной терапии отводится очень значимая роль. Всем больным высокого и очень высокого сердечно-сосудистого риска, а не только пациентам с сахарным диабетом и патологией почек, для достижения целевого уровня артериального давления и предупреждения осложнений гипертензии показана терапия, основанная на сочетании нескольких препаратов. Предпочтение следует отдавать препаратам, блокируюшим активность ренин-ангиотензин-альдостероновой системы в сочетании с диуретиками или блокаторами кальциевых каналов. Следует учитывать и нижний предел, ниже которого не следует снижать артериальное давление, особенно у больных ишемической болезнью сердца и мозга. Представлены данные сравнительного открытого исследования эффективности терапии различными классами антигипертензивных препаратов у женщин с гипертонической болезнью в постменопаузе. Показана высокая эффективность и хорошая переносимость Нолипрела - комбинированного препарата, в состав которого входит периндоприл и индапамид.

The paper is addressed to combination therapy in hypertension. The advantages of combination therapy, especially foxed combinations are discussed. Combination treatment of arterial hypertension should be the first line therapy in high or very high total cardiovascular risk patients to achieve target blood pressure and prevent complications. The combinations, including renin-angitensin-aldosterone system blocking agents are preferable. They can be combined with diuretics or calcium channel blockers. Physicians should take into consideration the lower limit of blood pressure which can be dangerous for patients with coronary artery disease and cerebrovascular disease. The results of open label randomized trial of efficacy and tolerability of different combinations of antihypertensive drugs in postmenopausal women are presented. High efficacy and toterability of fixed combination of ACE inhibitor perindopril and diuretic indapamide - Noliprel was shown.

артериальная гипертензияантигипертензивная терапияпостменопаузанолипрелarterial hypertensionantihypertensive treatmentmenopauseperindoprilindapamidefixed combinationReferencesHow well is hypertension controlled in Europe? European Society of Hypertension Scientific Newsletter: Update on Hypertension management. - 2007. - Vol. 8, № 3.How well is hypertension controlled in Europe? European Society of Hypertension Scientific Newsletter: Update on Hypertension management. - 2007. - Vol. 8, № 3.Zanchetti A., Hansson L., Clement D. et al. Benefits and risks of more intensive blood pressure lowering in hypertensive patients of the HOT study with different risk profile: does a J-shaped curve exist in smokers? // J. Hypertens. - 2003. - Vol. 21. - P. 797-804.Zanchetti A., Hansson L., Clement D. et al. Benefits and risks of more intensive blood pressure lowering in hypertensive patients of the HOT study with different risk profile: does a J-shaped curve exist in smokers? // J. Hypertens. - 2003. - Vol. 21. - P. 797-804.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in Type 2 diabetes. UKPDS // BMJ. - 1998. - Vol. 317. - P. 703-713.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in Type 2 diabetes. UKPDS // BMJ. - 1998. - Vol. 317. - P. 703-713.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. Hypertens. - 2007. - Vol. 25. - P. 1105-1187.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. Hypertens. - 2007. - Vol. 25. - P. 1105-1187.Диагностика и лечение артериальной гипертензии Рекомендации Российского медицинского общества по артериальной гипертонии Всероссийского научного общества кардиологов (третий пересмотр) // Кардиоваск. терапия и профилактика. - 2008. - T. 7, № 6 (Приложение).Диагностика и лечение артериальной гипертензии Рекомендации Российского медицинского общества по артериальной гипертонии Всероссийского научного общества кардиологов (третий пересмотр) // Кардиоваск. терапия и профилактика. - 2008. - T. 7, № 6 (Приложение).Arima H., Chalmers J., Woodward M. et al. PROGRESS Collaborative Group. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial // J. Hypertens. - 2006. - Vol. 24. - P. 1201-1208.Arima H., Chalmers J., Woodward M. et al. PROGRESS Collaborative Group. Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial // J. Hypertens. - 2006. - Vol. 24. - P. 1201-1208.The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease investigators. On reduction of cardiac events with Perindopril in stable coronary Artery disease investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicentre trial (the EUROPA study) // Lancet. - 2003. - Vol. 362. - P. 782-788.The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease investigators. On reduction of cardiac events with Perindopril in stable coronary Artery disease investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicentre trial (the EUROPA study) // Lancet. - 2003. - Vol. 362. - P. 782-788.Lubsen J., Wagener G., Kirwan B.A. et al. ACTION (A Coronary disease Trial Investigating Outcome with Nifidipine GITS) investigators. Effect of long-acting nifedipine on angina and hypertension: the ACTION trial // J. Hypertens. - 2005. - Vol. 23. - P. 641-648.Lubsen J., Wagener G., Kirwan B.A. et al. ACTION (A Coronary disease Trial Investigating Outcome with Nifidipine GITS) investigators. Effect of long-acting nifedipine on angina and hypertension: the ACTION trial // J. Hypertens. - 2005. - Vol. 23. - P. 641-648.Nissen S.E., Tuzcu E.M., Libbi P. et al. CAMELOT investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial // JAMA. - 2004. - Vol. 292. - P. 2217-2225.Nissen S.E., Tuzcu E.M., Libbi P. et al. CAMELOT investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial // JAMA. - 2004. - Vol. 292. - P. 2217-2225.Carretero O., Oparil S. Essential hypertension. Part I: definition and etiology // Circulation. - 2000. - Vol. 101. - P. 329-335.Carretero O., Oparil S. Essential hypertension. Part I: definition and etiology // Circulation. - 2000. - Vol. 101. - P. 329-335.Brenner B.M., Cooper M.E., de Zeeuw D. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy // N. Engl. J. Med. - 2001. - Vol. 345. - P. 861-869.Brenner B.M., Cooper M.E., de Zeeuw D. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy // N. Engl. J. Med. - 2001. - Vol. 345. - P. 861-869.Dahlof B., Sever P.S., Poulter N.R. et al. ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial // Lancet. - 2005. - Vol. 366. - P. 895-906.Dahlof B., Sever P.S., Poulter N.R. et al. ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial // Lancet. - 2005. - Vol. 366. - P. 895-906.Jamerson K.A., Bakris G.L., Wun C.C. et al. Rationale and design of the avoiding cardiovascular events through combination therapy in patients living with systolic hypertension (ACCOMPLISH) trial: the first randomized controlled trial to compare the clinical outcome effects of first-line combination therapies in hypertension // Am. J. Hypertens. - 2004. - Vol. 17. - P. 793-801.Jamerson K.A., Bakris G.L., Wun C.C. et al. Rationale and design of the avoiding cardiovascular events through combination therapy in patients living with systolic hypertension (ACCOMPLISH) trial: the first randomized controlled trial to compare the clinical outcome effects of first-line combination therapies in hypertension // Am. J. Hypertens. - 2004. - Vol. 17. - P. 793-801.Kostis J.B. Treating hypertension in the very old // N. Engl. J. Med. - 2008. - Vol. 358, № 18. - P. 1958-1960.Kostis J.B. Treating hypertension in the very old // N. Engl. J. Med. - 2008. - Vol. 358, № 18. - P. 1958-1960.Poulter N.R. Blood pressure and glucose control in subjects with diabetes: new analyses from ADVANCE // J. Hypertens. - 2009. - Vol. 27 (suppl. 1). - P. S3-S8.Poulter N.R. Blood pressure and glucose control in subjects with diabetes: new analyses from ADVANCE // J. Hypertens. - 2009. - Vol. 27 (suppl. 1). - P. S3-S8.Teo K., Yusuf S., Sleight P. et al. ONTARGET/TRANSCEND Investigators. Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination Study in ACE intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trials // Am. Heart J. - 2004. Vol. 148. - P. 52-61.Teo K., Yusuf S., Sleight P. et al. ONTARGET/TRANSCEND Investigators. Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination Study in ACE intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trials // Am. Heart J. - 2004. Vol. 148. - P. 52-61.Pepine C.J., Handberg E.M., Cooper-DeHoff R.M. et al. INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial // JAMA. - 2003. - Vol. 290. - P. 2805-2816.Pepine C.J., Handberg E.M., Cooper-DeHoff R.M. et al. INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial // JAMA. - 2003. - Vol. 290. - P. 2805-2816.Kjedsen S.E., Julius S., Mancia G. et al. VALUE Trial Investigators. Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial // J. Hypertens. - 2006. - Vol. 24. - P. 1405-1412.Kjedsen S.E., Julius S., Mancia G. et al. VALUE Trial Investigators. Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial // J. Hypertens. - 2006. - Vol. 24. - P. 1405-1412.Julius S., Kjeldsen S.E., Weber M. et al. VALUE trial group. Outcomes in hyperensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial // Lancet. - 2004. - Vol. 363. - P. 2022-2031.Julius S., Kjeldsen S.E., Weber M. et al. VALUE trial group. Outcomes in hyperensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial // Lancet. - 2004. - Vol. 363. - P. 2022-2031.Mancia G., Grassi G., Zanchetti A. New-onset diabetes and antihypertensive drugs // J. Hypertens. - 2006. - Vol. 24. - P. 3-10.Mancia G., Grassi G., Zanchetti A. New-onset diabetes and antihypertensive drugs // J. Hypertens. - 2006. - Vol. 24. - P. 3-10.Elliott W.J., Meyer P.M. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis // Lancet. - 2007. - Vol. 369. - P. 201-207.Elliott W.J., Meyer P.M. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis // Lancet. - 2007. - Vol. 369. - P. 201-207.Dahlof B., Grosse P., Gueret P. et al. The PICXEL Investigators. Perindopril/Indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study // J. Hypertens. - 2005. - Vol. 23. - P. 2063-2070.Dahlof B., Grosse P., Gueret P. et al. The PICXEL Investigators. Perindopril/Indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study // J. Hypertens. - 2005. - Vol. 23. - P. 2063-2070.Mogensen C.E., Viberti G., Halimi S. et al. Preterax in Albuminuria Regression (PREMIER) Study Group. Effect of low-dose perindopril/indapamide on albuminuria in diabetes: Preterax in albuminuria regression: PREMIER // Hypertension. - 2003. - Vol. 41. - P. 1063-1071.Mogensen C.E., Viberti G., Halimi S. et al. Preterax in Albuminuria Regression (PREMIER) Study Group. Effect of low-dose perindopril/indapamide on albuminuria in diabetes: Preterax in albuminuria regression: PREMIER // Hypertension. - 2003. - Vol. 41. - P. 1063-1071.Chalmers J., Castaigne A., Morgan T. et al. Long-term efficacy of a new fixed very low dose angiotensin-coverting enzyme-inhibitor/diuretic combination as first line therapy in the elderly hypertensive patients // Am. J. Hypertens. - 2000. - Vol. 18. - P. 327-337.Chalmers J., Castaigne A., Morgan T. et al. Long-term efficacy of a new fixed very low dose angiotensin-coverting enzyme-inhibitor/diuretic combination as first line therapy in the elderly hypertensive patients // Am. J. Hypertens. - 2000. - Vol. 18. - P. 327-337.Маслова Н.П., Баранова Е.И. Гипертоническая болезнь у женщин. - СПб: издательство СПбГМУ, 2000. - 214 с.Маслова Н.П., Баранова Е.И. Гипертоническая болезнь у женщин. - СПб: издательство СПбГМУ, 2000. - 214 с.

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