arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2019-25-4-376-388arthyper-1895Research ArticleОбзоры и лекцииReviewГидрохлоротиазид и риск развития немеланомного рака кожи: критический анализ данныхHydrochlorothiazide and the risk of non-melanoma skin cancer: a critical reviewКобалаваЖ. Д.KobalavaZh. D.

Кобалава Жанна Давидовна — доктор медицинских на­ук, профессор, заведующая кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева

Москва

Zhanna D. Kobalava, MD, PhD, DSc, Professor, Head, Department of Internal Medicine with Course of Cardiology and Functional Diagnostics named after V. S. Moiseev, RUDN University

Moscow

КоханЕ. В.KokhanE. V.

Кохан Елизавета Васильевна — клинический ординатор кафедры внутренних болезней с курсом кардиологии и функ­циональной диагностики имени академика В. С. Моисеева

ул. Вавилова, д. 61,  Москва, 117292

Elizaveta V. Kokhan, MD, Resident, Department of Internal Medicine with Course of Cardiology and Functional Diagnostics named after V. S. Moiseev, RUDN University

61 Vavilov street, Moscow, 117292

kokhhan@gmail.comКиякбаевГ. К.KiyakbaevG. K.

Киякбаев Гайрат Калуевич — доктор медицинских наук, профессор, профессор кафедры внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева

Москва

Gayrat K. Kiyakbaev, MD, PhD, DSc, Professor, Department of Internal Medicine with Course of Cardiology and Functional Diagnostics named after V. S. Moiseev, RUDN UniversityMoscow

Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»РоссияPeoples’ Friendship University of RussiaRussian Federation201910122019254376388Copyright © Кобалава Ж.Д., Кохан Е.В., Киякбаев Г.К., 20192019Кобалава Ж.Д., Кохан Е.В., Киякбаев Г.К.Kobalava Z.D., Kokhan E.V., Kiyakbaev G.K.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/1895

Несколько крупных исследований последних лет, основные из которых выполнены в Дании, выяви­ли ассоциацию между приемом гидрохлоротиазида (ГХТ) и риском развития немеланомного рака кожи. В качестве ключевого патофизиологического механизма, объясняющего такую связь, рассматривается фотосенсибилизирующий эффект, присущий многим антигипертензивным препаратам. Результаты этих работ послужили основанием для обновления рекомендаций Европейского медицинского агентства по безопасности ГХТ. Однако данные, убедительно демонстрирующие причинно-следственный харак­тер выявленных ассоциаций, на сегодняшний день отсутствуют. Их обсуждение, несмотря на невысокую распространенность рака кожи, стало возможным благодаря накопленному масштабному пулу инфор­мации о применении ГХТ — самого распространенного диуретика в мире. При этом к существенным ограничениям исследований по оценке связи между приемом препарата и риском развития рака кожи можно отнести их ретроспективный характер, обследование ограниченной популяции и отсутствие уче­та влияния ряда важных вмешивающихся факторов. В связи с чем интерпретация полученных в них ре­зультатов должна быть крайне осторожной, в противном случае это может повлечь за собой существен­ное ухудшение качества контроля артериальной гипертонии из-за снижения приверженности к лечению, необоснованной отмены или замены ГХТ, в том числе фиксированных с ним комбинаций, на препараты с другими тиазидными и тиазидоподобными диуретиками, которые также обладают фотосенсибилизи­рующими свойствами.

Several recent large studies, most of which were performed in Denmark, have revealed a link between hydrochlorothiazide use and the risk of non-melanoma skin cancer. Photosensitizing properties of hydrochlorothiazide, inherent in many antihypertensive drugs, are considered a key pathophysiological mechanism underlying this association. The results of these studies prompted an update to the recommendations of the European Medical Agency for the safety of hydrochlorothiazide. However, to date there have been no convincing evidence of causality of this association. The accumulation of data on usage of hydrochlorothiazide, the most widely used diuretic worldwide, made the discussion of this association possible despite the low prevalence of skin cancer. At the same time, the retrospective design of these studies should be considered, as well as limited sample and lack of adjustment for important confounders. Therefore, the results obtained in these studies must be interpreted with extreme caution to prevent the decrease in hypertension control due to reduced compliance with treatment, unjustified withdrawal or replacement of hydrochlorothiazide, including its fixed combinations, with other thiazide or thiazide-like diuretics, which also have photosensitizing action.

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