arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive Leaguearthyper-1669Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESАнтигипертензивная терапия и ригидность артериальной стенки у больных пожилого возраста с неклапанной фибрилляцией предсердийШевелёвВ. И.ShevelyovV. I.vadimecho@mail.ruКанорскийС. Г.KanorskyS. G.noemail@neicon.ruМУЗ Городская больница № 2 «Краснодарское многопрофильное лечебно-диагностическое объединение»РоссияClinical Hospital «Krasnodar Multifield Clinical and Diagnostic Iinstitution»Russian FederationГБОУ ВПО «Кубанский государственный медицинский университет Минздравсоцразвития России»РоссияKuban State Medical UniversityRussian Federation201128122011176560566Copyright © Шевелёв В.И., Канорский С.Г., 20112011Шевелёв В.И., Канорский С.Г.Shevelyov V.I., Kanorsky S.G.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/1669

Жесткость артериальной стенки является независимым предиктором сердечно-сосудистых осложнений и смертности от сердечно-сосудистых причин, поэтому актуален поиск наиболее эффективных терапевтических средств, позволяющих улучшать упругоэластические свойства артериального русла. Цель исследования - сравнить влияние ингибитора ангиотензинпревращающего фермента (периндоприла), дигидропиридинового антагониста кальция (лерканидипина), блокатора рецепторов к ангиотензину II (валсартана) и его комбинации со статином (розувастатином) на эластичность артериальной стенки у пациентов пожилого возраста с неклапанной фибрилляцией предсердий (ФП) и артериальной гипертензией (АГ) на основании данных ультразвукового исследования. Материалы и методы. Обследовано 189 пациентов (110 мужчин и 79 женщин) в возрасте от 65 до 80 лет с неклапанной ФП и АГ, которых рандомизировали на четыре группы. В первой группе (n = 47) применялся периндоприл в дозе 5-10 мг/сутки, во второй (n = 48) - валсартан в дозе 80-160 мг/сутки, в третьей (n = 48) - валсартан в той же дозе в комбинации с розувастатином по 10 мг/сутки, в четвертой (n = 46) - лерканидипин в дозе 10-20 мг/сутки. В исходном состоянии, через 1 и 2 года оценивались уровни артериального давления, упругоэластические свойства грудного отдела аорты и сонных артерий по данным ультразвукового исследования и сердечно-сосудистые осложнения. Результаты. При всех четырех вариантах терапии повышался индекс растяжимости общей сонной артерии, снижались коэффициент жесткости аортальной стенки и скорость распространения пульсовой волны по сравнению с исходным состоянием. Комбинация валсартана с розувастатином оказывала наиболее выраженное влияние на податливость сосудистой стенки, снижала частоту ишемического инсульта, инфаркта миокарда и смертность. Заключение. При выборе антигипертензивной терапии у геронтологических больных с неклапанной ФП валсартан в сочетании с розувастатином могут рассматриваться в качестве оптимальной стратегии, позволяющей улучшить упругоэластические свойства артериальной стенки и снизить частоту кардиоваскулярных осложнений.

Stiffness of the arterial wall is an independent predictor of cardiovascular morbidity and mortality from cardiovascular causes. Therefore, search for more effective therapeutic approaches to improve the elasticity properties of the arterial wall are necessary. Objective. Compare the effects of angiotensin-converting enzyme (perindopril), dihydropyridine calcium antagonist (lercanidipine), angiotensin receptor blockers II (valsartan) and its combination with a statin (rosuvastatin) for the elasticity of the arterial wall in elderly patients with nonvalvular atrial fibrillation (AF) and hypertension (AG) on the basis of ultrasound examination. Design and methods. We examined 189 patients (110 men and 79 women) aged 65 to 80 years with nonvalvular atrial fibrillation and hypertension, which were randomly assigned to four groups. Patients in the first group (n = 47) took perindopril in the dose of 5-10 mg/day, in the second (n = 48) - valsartan at the dose of 80-160 mg/day, in the third (n = 48) - valsartan at the same dose in combination with rosuvastatin 10 mg/day, in the fourth (n = 46) - lercanidipine at the dose of 10-20 mg/day. At baseline, after 1 and 2 years blood pressure levels, elastic properties of the thoracic aorta and carotid arteries by ultrasound and cardiovascular complications were assessed. Results. Treatment increased distensibility index of the common carotid artery, decreased stiffness aortic wall and pulse wave velocity in all four groups compared to baseline. The combination of valsartan with rosuvastatin exerted the most pronounced effect on the vascular wall compliance, reduces the frequency of ischemic stroke, myocardial infarction, and mortality. Conclusion. Valsartan in combination with rosuvastatin may be regarded as the best strategy to improve the elastic properties of the arterial wall and reduce the incidence of cardiovascular complications in geriatric patients with nonvalvular AF.

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