Выбор препарата для лечения сердечно-сосудистых заболеваний у больных с метаболическим синдромом и сахарным диабетом
Нарушения метаболизма, нефропатия часто встречаются при сердечно-сосудистых заболеваниях, увеличивая риск развития осложнений, ухудшая прогноз и затрудняя выбор антигипертензивного, антиишемического препарата. Выбирая тот или иной препарат для лечения артериальной гипертонии, ишемической болезни сердца, необходимо учитывать его влияние на уровень глюкозы, липидный спектр, имеющуюся альбуминурию. В статье рассматривается влияние на углеводный и липидный виды обмена, а также на альбуминурию препаратов, часто применяемых для лечения сердечно-сосудистых заболеваний, таких как ингибиторы ангиотензинпревращающего фермента и сартаны, b-адреноблокаторы и диуретики, статины и антиишемические препараты 2-й линии. Правильный выбор препарат позволит избежать усугубления имеющихся у пациентов метаболических нарушений, а у больных с метаболическим синдромом предупредить развитие сахарного диабета.
Ключевые слова: сердечно-сосудистые заболевания, артериальная гипертензия, сахарный диабет, метаболический синдром, ингибиторы ангиотензинпревращающего фермента, сартаны, диуретики, b-адреноблокаторы, моксонидин, глюкоза, гликированный гемоглобин, липиды.
1. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31 (10): 1925–38. DOI: 10.1097/HJH.0b013e328364ca4c
2. Российское кардиологическое общество. Артериальная гипертензия у взрослых: Клинические рекомендации. 2020. https://webmed.irkutsk.ru/doc/pdf/fedhypert.pdf
[Rossiyskoe kardiologicheskoe obshchestvo. Arterial'naya gipertenziya u vzroslykh: Klinicheskie rekomendatsii. 2020. https://webmed.irkutsk.ru/doc/pdf/fedhypert.pdf (in Russian).]
3. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317 (7160): 703–13.
4. Galletti F, Strazzullo P, Capaldo B et al. Controlled study of the effect of angiotensin converting enzyme inhibition versus calcium-entry blockade on insulin sensitivity in overweight hypertensive patients: Trandolapril Italian Study (TRIS). J Hypertens 1999; 17 (3): 439–45. DOI: 10.1097/00004872-199917030-00018
5. Shiuchi T, Cui TX, Wu L et al. ACE inhibitor improves insulin resistance in diabetic mouse via bradykinin and NO. Hypertension 2002; 40 (3): 329–34. DOI: 10.1161/01.hyp.0000028979.98877.0c
6. Heart Outcomes Prevention Evaluation Study Investigators (НОРЕ), Yusuf S, Sleight P et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342 (3): 145–53. DOI: 10.1056/NEJM200001203420301
7. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288 (23): 2981–97. DOI: 10.1001/jama.288.23.2981
8. Niskanen L, Hedner T, Hansson L et al. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Diabetes Care 2001; 24 (12): 2091–6. DOI: 10.2337/diacare.24.12.2091
9. Turnbull F; Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362 (9395): 1527–35. DOI: 10.1016/s0140-6736(03)14739-3
10. Law MR, Morris JK, Wald NJ. 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
11. Dahlöf B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359 (9311): 995–1003. DOI: 10.1016/S0140-6736(02)08089-3
12. Benson SC, Pershadsingh HA, Ho CI et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARgamma-modulating activity. Hypertension 2004; 43 (5): 993–1002. DOI: 10.1161/01.HYP.0000123072.34629.57
13. Vitale C, Mercuro G, Castiglioni C et al. Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome. Cardiovasc Diabetol 2005; 4: 6. DOI: 10.1186/1475-2840-4-6
14. Takagi H, Umemoto T. Telmisartan improves insulin sensitivity: a meta-analysis of randomized head-to-head trials. Int J Cardiol 2012; 156 (1): 92–6. DOI: 10.1016/j.ijcard.2011.11.070
15. Derosa G, Ragonesi PD, Mugellini et al. Effects of telmisartan compared with eprosartan on blood pressure control, glucose metabolism and lipid profile in hypertensive, type 2 diabetic patients: a randomized, double-blind, placebo-controlled 12-month study. Hypertens Res 2004; 27 (7): 457–64. DOI: 10.1291/hypres.27.457
16. Brenner BM, Cooper ME, de Zeeuw D et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345 (12): 861–9. DOI: 10.1056/NEJMoa011161
17. Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345 (12): 851–60. DOI: 10.1056/NEJMoa011303
18. Parving HH, Lehnert H, Bröchner-Mortensen J et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345 (12): 870–8. DOI: 10.1056/NEJMoa011489
19. Viberti G, Wheeldon NM; MicroAlbuminuria Reduction With VALsartan (MARVAL) Study Investigators. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure-independent effect. Circulation 2002; 106 (6): 672–8. DOI: 10.1161/01.cir.0000024416.33113.0a
20. Suzuki K, Souda S, Ikarashi T et al. Renoprotective effects of low-dose valsartan in type 2 diabetic patients with diabetic nephropathy. Diabetes Res Clin Pract 2002; 57 (3): 179–83. DOI: 10.1016/s0168-8227(02)00098-0
21. Hollenberg NK, Parving HH, Viberti G et al. Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. J Hypertens 2007; 25 (9): 1921–6. DOI: 10.1097/HJH.0b013e328277596e
22. Barnett AH, Bain SC, Bouter P et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351 (19): 1952–61. DOI: 10.1056/NEJMoa042274
23. Makino H, Haneda M, Babazono T et al. Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: a post-hoc analysis of The Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study. Hypertens Res 2008; 31 (4): 657–64. DOI: 10.1291/hypres.31.657
24. Schmieder RE, Delles C, Mimran A et al. Impact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and type 2 diabetes. Diabetes Care 2007; 30 (6): 1351–6. DOI: 10.2337/dc06-1551
25. Ikeda H, Hamamoto Y, Honjo S et al. Olmesartan reduced microalbuminuria in Japanese subjects with type 2 diabetes. Diabetes Res Clin Pract 2009; 83 (1): 117–8. DOI: 10.1016/j.diabres.2008.10.013
26. Dahlöf B, Sever PS, Poulter NR et al. 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 randomised controlled trial. Lancet 2005; 366 (9489): 895–906. DOI: 10.1016/S0140-6736(05)67185-1
27. Wai B, Kearney LG, Hare DL et al. Beta blocker use in subjects with type 2 diabetes mellitus and systolic heart failure does not worsen glycaemic control. Cardiovasc Diabetol 2012; 11: 14. DOI: 10.1186/1475-2840-11-14
28. Janka HU, Ziegler AG, Disselhoff G, Mehnert H. Influence of bisoprolol on blood glucose, glucosuria, and haemoglobin A1 in noninsulin-dependent diabetics. J Cardiovasc Pharmacol 1986; 8 (Suppl. 11): S96–9. DOI: 10.1097/00005344-198511001-00018
29. Jacob S, Balletshofer B, Henriksen EJ et al. Beta-blocking agents in patients with insulin resistance: effects of vasodilating beta-blockers. Blood Press 1999; 8 (5–6): 261–8. DOI: 10.1080/080370599439463
30. Giugliano D, Acampora R, Marfella R et al. Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial. Ann Intern Med 1997; 126 (12): 955–9. DOI: 10.7326/0003-4819-126-12-199706150-00004
31. Bakris GL, Fonseca V, Katholi RE et al. Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA 2004; 292 (18): 2227–36. DOI: 10.1001/jama.292.18.2227
32. Cleophas TJ. Experimental evidence of selective antagonistic action of Nebivolol on β1-adrenergic receptors. J Clin Med 1998; 2: 1–8.
33. Van Nueten J.M. et al. In vitro pharmacological profile of R065824, a potent and selective β1-adrenergic antagonist. JRF Preclinical Research Report R065834/8. 1985 Nov.
34. Kallistratos MS, Poulimenos LE, Manolis AJ. Vasodilator β-blockers: a different class of antihypertensive agents? Future Cardiol 2014; 10 (6): 669–71. DOI: 10.2217/fca.14.51
35. Zanchetti A. Clinical pharmacodynamics of nebivolol: new evidence of nitric oxide-mediated vasodilating activity and peculiar haemodynamic properties in hypertensive patients. Blood Press Suppl 2004; 1: 17–32. DOI: 10.1080/08038020410016548
36. Badar VA, Hiware SK, Shrivastava MP et al. Comparison of nebivolol and atenolol on blood pressure, blood sugar, and lipid profile in patients of essential hypertension. Indian J Pharmacol 2011; 43 (4): 437–40. DOI: 10.4103/0253-7613.83117
37. Мычка В.Б., Жернакова Ю.В., Зюзина Н.Е. и др. Эффективность небиволола у больных сахарным диабетом и метаболическим синдромом. Consilium Medicum. 2008; 10 (5): 86–90.
[Mychka V.B., Zhernakova Yu.V., Zyuzina N.E. et al. Effektivnost' nebivolola u bol'nykh sakharnym diabetom i metabolicheskim sindromom. Consilium Medicum. 2008; 10 (5): 86–90 (in Russian).]
38. Schmidt AC, Graf C, Brixius K, Scholze J. Blood pressure-lowering effect of nebivolol in hypertensive patients with type 2 diabetes mellitus: the YESTONO study. Clin Drug Investig 2007; 27 (12): 841–9. DOI: 10.2165/00044011-200727120-00006
39. Agabiti Rosei E, Rizzoni D. Metabolic profile of nebivolol, a beta-adrenoceptor antagonist with unique characteristics. Drugs 2007; 67 (8): 1097–107. DOI: 10.2165/00003495-200767080-00001
40. Sarafidis PA, Bakris GL. Antihypertensive therapy and the risk of new-onset diabetes. Diabetes Care 2006; 29 (5): 1167–9. DOI: 10.2337/diacare.2951167
41. Fernández R, Puig JG, Rodríguez-Pérez JC et al. Effect of two antihypertensive combinations on metabolic control in type-2 diabetic hypertensive patients with albuminuria: a randomised, double-blind study. J Hum Hypertens 2001; 15 (12): 849–56. DOI: 10.1038/sj.jhh.1001279
42. Reyes AJ, Chiesa PD, Santucci MR et al. Hydrochlorothiazide versus a non-diuretic dose of torasemide as once-daily antihypertensive monopharmacotherapy in elderly patients. A randomized and double-blind study. Prog Pharmacol Clin Pharmacol 1990; 8 (1): 183–209.
43. Sanjuliani AF, Genelhu de Abreu V, Ueleres Braga J et al. Effects of moxonidine on the sympathetic nervous system, blood pressure, plasma renin activity, plasma aldosterone, leptin, and metabolic profile in obese hypertensive patients. J Clin Basic Cardiol 2004; 7: 19–25.
44. Derosa G, Cicero AF, D'Angelo A et al. Metabolic and antihypertensive effects of moxonidine and moxonidine plus irbesartan in patients with type 2 diabetes mellitus and mild hypertension: a sequential, randomized, double-blind clinical trial. Clin Ther 2007; 29 (4): 602–10. DOI: 10.1016/j.clinthera.2007.03.015
45. Chazova I, Almazov VA, Shlyakhto E. Moxonidine improves glycaemic control in mildly hypertensive, overweight patients: a comparison with metformin. Diabetes Obes Metab 2006; 8 (4): 456–65. DOI: 10.1111/j.1463-1326.2006.00606.x
46. Мычка В.Б., Тишина Е.В., Жернакова Ю.В. и др. Значение агониста имидазолиновых рецепторов моксонидина в лечении больных артериальной гипертонией и метаболическим синдромом. Результаты исследования MERSY в России. Системные гипертензии. 2010; 1: 52–6.
[Mychka V.B., Tishina E.V., Zhernakova Yu.V. et al. Znachenie agonista imidazolinovykh retseptorov moksonidina v lechenii bol'nykh arterial'noy gipertoniey i metabolicheskim sindromom. Rezul'taty issledovaniya MERSY v Rossii. Systemic Hypertension. 2010; 1: 52–6 (in Russian).]
47. Чазова И.Е., Недогода С.В., Жернакова Ю.В. и др. Рекомендации по ведению больных артериальной гипертонией с метаболическими нарушениями. Кардиологический вестник. 2014; 9 (1): 3–57.
[Chazova I.E., Nedogoda S.V., Zhernakova Yu.V. et al. Rekomendatsii po vedeniyu bol'nykh arterial'noy gipertoniey s metabolicheskimi narusheniyami. Russian Cardiology Bulletin. 2014; 9 (1): 3–57 (in Russian).]
48. Zoungas S, Chalmers J et al. Association of HbA1c levels with vascular complications and death in patients with type 2 diabetes: evidence of glycaemic thresholds. Diabetologia 2013; 3: 61–6.
49. Martinez-Martin FJ, Rodriguez-Rosas H, Peiro-Martinez I et al. Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study. J Hum Hypertens 2011; 25 (6): 346–53. DOI: 10.1038/jhh.2010.104
50. Teramoto T, Shimano H, Yokote K, Urashima M. New evidence on pitavastatin: efficacy and safety in clinical studies. Expert Opin Pharmacother 2010; 11 (5): 817–28. DOI: 10.1517/14656561003641990
51. Yamazaki T, Kishimoto J, Ito C et al. Japan Prevention Trial of Diabetes by Pitavastatin in Patients with Impaired Glucose Tolerance (the J-PREDICT study): rationale, study design, and clinical charasteristics of 1269 patients. Diabetol Int 2011; 2: 134–40.
52. Huang CH, Huang YY, Hsu BR. Pitavastatin improves glycated hemoglobin in patients with poorly controlled type 2 diabetes. J Diabetes Investig 2016; 7 (5): 769–76. DOI: 10.1111/jdi.12483
53. Wang YB, Fu XH, Gu XS et al. Effects of intensive pitavastatin therapy on glucose control in patients with non-ST elevation acute coronary syndrome. Am J Cardiovasc Dis 2017; 7 (4): 89–96
54. Fragasso G, Piatti Md PM, Monti L et al. Short- and long-term beneficial effects of trimetazidine in patients with diabetes and ischemic cardiomyopathy. Am Heart J 2003; 146 (5): E18. DOI: 10.1016/S0002-8703(03)00415-0
55. Chaitman BR, Pepine CJ, Parker JO et al. Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA 2004; 291 (3): 309–16. DOI: 10.1001/jama.291.3.309
56. Chisholm JW, Goldfine AB, Dhalla AK et al. Effect of ranolazine on A1C and glucose levels in hyperglycemic patients with non-ST elevation acute coronary syndrome. Diabetes Care 2010; 33 (6): 1163–8. DOI: 10.2337/dc09-2334
57. Timmis AD, Chaitman BR, Crager M. Effects of ranolazine on exercise tolerance and HbA1c in patients with chronic angina and diabetes. Eur Heart J 2006; 27 (1): 42–8. DOI: 10.1093/eurheartj/ehi495
58. Kosiborod M, Arnold SV, Spertus JA et al. Evaluation of ranolazine in patients with type 2 diabetes mellitus and chronic stable angina: results from the TERISA randomized clinical trial (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina). J Am Coll Cardiol 2013; 61 (20): 2038–45. DOI: 10.1016/j.jacc.2013.02.011