PharmatecaPharmatecaФарматека2073-40342414-9128Bionika Media286974ArticlesСтатьиResearch ArticleMOKSONIDIN V LEChENII ARTERAL'NOY GIPERTENZII: EFFEKTIVNOST' V KOMBINIROVANNOY TERAPII I DOPOLNITEL'NYE POKAZANIYaМОКСОНИДИН В ЛЕЧЕНИИ АРТЕРАЛЬНОЙ ГИПЕРТЕНЗИИ: ЭФФЕКТИВНОСТЬ В КОМБИНИРОВАННОЙ ТЕРАПИИ И ДОПОЛНИТЕЛЬНЫЕ ПОКАЗАНИЯMinushkinaL. OМинушкинаЛ. О

д.м.н., проф. кафедры терапии, кардиологии и функциональной диагностики с курсом нефрологии

minushkina@mail.ruФГБУ «Учебно-научный медицинский центр» УД Президента РФ, Москва10052014219NO9 (2014)№9 (2014)656926022023Copyright ©; 2014, Bionika MediaCopyright ©; 2014, ООО «Бионика Медиа»2014Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/2073-4034/article/view/286974

Blood pressure cannot be controlled in 20-30 % of patients, even against the background of receiving a combination of 3-4 drugs from major groups. In the pathogenesis of arterial hypertension (AH), activation of the sympathetic nervous system (SNS) plays an important role. Antihypertensive medications with central action help to reduce tone of SNS nuclei. Moxonidine belongs to this group of antihypertensive drugs. The article presents the data on the antihypertensive efficacy of moxonidine, and potentials for the combination therapy of arterial hypertension. The literature data on the impact of moxonidine on carbohydrate metabolism and insulin sensitivity are discussed. Potential benefits of use of this drug in patients with overweight, metabolic syndrome, diabetes, as well as in elderly patients and postmenopausal women are demonstrated. Data on organoprotective features of moxonidine - effects on endothelial function, microalbuminuria, and cardiac hypertrophy - are analyzed.

Артериальное давление не удается контролировать 20-30 % больных даже на фоне приема комбинации из 3-4 лекарственных препаратов основных групп. В патогенезе артериальной гипертензии (АГ) важную роль играет активация симпатической нервной системы (СНС). Антигипертензивные препараты центрального действия способствуют снижению тонуса ядер СНС. Моксонидин относится к этой группе антигипертензивных препаратов. Представлены данные об антигипертензивной эффективности моксонидина, возможностях комбинированной терапии АГ. Представлены данные литературы о влиянии терапии моксонидином на углеводный обмен, чувствительность тканей к инсулину. Показана возможная польза от применения препарата больными избыточной массой тела, метаболическим синдромом, сахарным диабетом, пожилыми больными, женщинами в постменопаузе. Анализируются данные об органопротективных свойствах моксонидина: влияние препарата на функцию эндотелия, микроальбуминурию, гипертрофию миокарда.

arterial hypertensionmetabolic syndromeinsulin resistancepostmenopausemoxonidineартериальная гипертензияметаболический синдроминсулинорезистентностьпостменопаузамоксонидинBrown M.A., Buddle M.L., Martin A. Is resistant hypertension really resistant? Am. J. Hypertens. 2001; 14(12): 1263-69.Krause T., Lovibond K.,Caulfield M., McCormack T., Williams B. Guideline Development Group. Management of hypertension: summary of NICE guidance. BMJ. 2011; 343: d4891.Go A.S., Bauman M.A., Coleman King S.M., et al. An effective approach to high blood pressure control: a science advisory from the american heart association, the american college of cardiology, and the centers for disease control and prevention. J. Am. Coll. Cardiol. 2014; 63(12): 1230-38Mancia 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 European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 2013; 34(28): 2159-219van Zwieten P.A., Mancia G. Background and treatment of metabolic syndrome: a therapeutic challenge. Semin Cardiothorac Vasc Anesth. 2006; 10(3): 206-14.Gupta S., Sharma B. Pharmacological modulation of I(1)-imidazoline and α2-adrenoceptors in sub acute brain ischemia induced vascular dementia. Eur. J. Pharmacol. 2014; 723: 80-90.Tsutsui H., Sugiura T., Hayashi K., et al. Protective effect of moxonidine on ischemia/reperfusioninduced acute kidney injury through α2/imidazoline I1 receptor. Eur. J. Pharmacol. 2013; 718(1-3): 173-80.Wang J.L., Wang L., Wu Z.T., et al. Low dose of moxonidine within the rostral ventrolateral medulla improves the baroreflex sensitivity control of sympathetic activity in hypertensive rat. Acta Pharmacol. Sin. 2009; 30(12): 1594-600.de Andrade C.A., de Andrade G.M., De Paula P.M., et al. Involvement of central alphal-adrenoceptors on renal responses to central moxonidine and alpha-methylnoradrenaline. Eur. J. Pharmacol. 2009; 607(1-3): 60-7.Cao C., Kang C.W., Kim S.Z., Kim S.H. Augmentation of moxonidine-induced increase in ANP release by atrial hypertrophy. Am. J. Physiol. Heart Circ. Physiol. 2004; 287(1): H150-56.He M.M., Abraham T.L., Lindsay T.J., et al. Metabolism and disposition of the antihypertensive agent moxonidine in humans. Drug Metab. Dispos. 2003; 31(3): 334-42.Kuppers H.E., Jager B.A., Luszick J.H., et al. Placebo-controlled comparison of the efficacy and tolerability of once-daily moxonidine and enalaprilin mild-to-moderate essentialhypertension. J. Hypertens. 1997; 15(1): 93-7.Rupp H., Maisch B., Brilla C.G. Drug withdrawal and rebound hypertension: differential action of the central antihypertensive drugs moxonidine and clonidine. Cardiovasc Drugs Ther. 1996; 10(Suppl 1): 251-62.Mitrovic V., Hamel M., Miric M., et al. Effect of the imidazoline receptor agonist moxonidine on hemodynamics, coronary circulation, metabolic ischemia markers and the neurohumoral system in patients with essential hypertension. Effects of moxonidine on coronary circulation Z Kardiol. 2001; 90(12): 953-63.Sagarad S.V., Biradar-Kerure S., Mr R., Kumar S.C., Reddy S.S. A Prospective Real World Experience of Moxonidine Use in Indian Hypertensive Patients-Prescription beyond Current Guidelines. J. Clin. Diagn Res. 2013; 7(10): 2213-15.Krupicka J., Soucek M., Chroust K. The efficacy and safety of moxonidine in patients with metabolic syndrome (the O.B.E.Z.I.T.A. trial)]. Vnitr Lek. 2011; 57(6): 541-45.Scwarz W., Kandziora J. Long-term experiences with moxonidine, a new antihypertensive agent. Forschr Med 1990; 108: 616-20.Schachter M., Luszick J., Jager B., et al. Safety and tolerability of moxonidine in the treatment of hypertension. Drug Saf. 1998; 19(3): 191-203.Prichard B.N., Jager B.A., Luszick J.H., et al. Placebo-controlled comparison of the efficacy and tolerability of once-daily moxonidine and enalapril in mild to moderate essential hypertension. Blood Press. 2002; 11(3): 166-72.Kraft K., Vetter H. Twenty-for-hour blood pressure ptofiles in patients with mild-to moderate hypertension. moxonidine versus captopril. J. Cardiovasc. Pharmacol. 1994; 24: s29-33Frei M., Kuster L., Gardosch von Krosigk P.P. et al. Moxonidine and hydrochlorotiazide in combination. a synergistic antihypertensive effect. J. Cardiovasc Pharmacol 1994; 24: 25-8.Topal E., Cikim A.S., Cikim K., et al. The effect of moxonidine on endothelial dysfunction in metabolic syndrome. Am. J. Cardiovasc. Drugs. 2006; 6(5): 343-48.Masajtis-Zagajewska A., Majer J., Nowicki M. Effect of moxonidine and amlodipine on serum YKL-40, plasma lipids and insulin sensitivity in insulin-resistant hypertensive patients-a randomized, crossover trial. Hypertens Res. 2010; 33(4): 348-53.Krespi P.G., Makris T.K., Hatzizacharias A.N., et al. Moxonidine effect on microalbuminuria, thrombomodulin, and plasminogen activator inhibitor-1 levels in patients with essential hypertension. Cardiovasc. Drugs Ther. 1998; 12(5): 463-67.Littlewood K.J., Greiner W., Baum D., et al. Adjunctive treatment with moxonidine versus nitrendipine for hypertensive patients with advanced renal failure: a cost-effectiveness analysis. BMC Nephrol. 2007; 8: 9.Paquette P.A., Duguay D., El-Ayoubi R., et al. Control of left ventricular mass by moxonidine involves reduced DNA synthesis and enhanced DNA fragmentation. Br. J. Pharmacol. 2008; 153(3): 459-67.Deftereos S., Giannopoulos G., Kossyvakis C., et al. Effectiveness of moxonidine to reduce atrial fibrillation burden in hypertensive patients. Am. J. Cardiol. 2013; 112(5): 684-87.Sharma A.M., Wagner T., Marsalek P. Moxonidine in the treatment of overweight and obese patients with the metabolic syndrome: a postmarketing surveillance study. J Hum Hypertens. 2004; 18(9): 669-75.Derosa G., Cicero A.F., 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.Haenni A., Lithell H. Moxonidine improves insulin sensitivity in insulin-resistant hypertensives. J Hypertens Suppl. 1999; 17(3): S29-35.Velliquette R.A., Ernsberger P. Contrasting metabolic effects of antihypertensive agents. J. Pharmacol. Exp. Ther. 2003; 307(3): 1104-11.Jacob S., Klimm H.J., Rett K., et al. Effects of moxonidine vs. metoprolol on blood pressure and metabolic control in hypertensive subjects with type 2 diabetes. Exp. Clin. Endocrinol. Diabetes. 2004; 112(6): 315-22.Martin U., Hill C., O' Mahony D. Use of moxonidine in elderly patients with resistant hypertension. J. Clin. Pharm. Ther. 2005; 30(5): 433-37.Kujala S.M., Pöyhönen-Alho M., Kaaja R.J. Effects of sympatholytic therapy on postmenopausal symptoms in hypertensive postmenopausal women. Climacteric. 2013 Nov 8. [Epub ahead of print].Kaaja R., Kujala S., Manhem K., et al. Effects of sympatholytic therapy on insulin sensitivity indices in hypertensive postmenopausal women. Int. J. Clin. Pharmacol Ther. 2007; 45(7): 394-401.Kaaja R., Manhem K., Tuomilehto J. Treatment of postmenopausal hypertension with moxonidine, a selective imidazoline receptor agonist. Int. J. Clin. Pract. Suppl. 2004; (139): 26-32.Pöyhönen-Alho M.K., Manhem K., Katzman P., et al. Central sympatholytic therapy has anti-inflammatory properties in hypertensive postmenopausal women. J. Hypertens. 2008; 26(12): 2445-49.Ebinc H., Ozkurt Z.N., Ebinc F.A., et al. Effects of sympatholytic therapy with moxonidine on serum adiponectin levels in hypertensive women. J. Int. Med. Res. 2008; 36(1): 80-7.