Systemic HypertensionSystemic HypertensionСистемные гипертензии2075-082X2542-2189Intermedservice Ltd2961310.26442/2075-082X_2018.2.72-76ArticlesСтатьиResearch ArticleNitrogen oxide biochemical pathway in pulmonary arterial hypertension therapy and REPLACE trial resultsБиохимический путь оксида азота в терапии легочной артериальной гипертензии и результаты исследования RESPITEShmaltsA AШмальцАнтон Алексеевич

д-р мед. наук, вед. науч. сотр. отд-ния хирургического лечения заболеваний сердца с прогрессирующей легочной гипертензией, доц. каф. сердечно-сосудистой хирургии

shmaltzanton@inbox.ruGorbachevskyS VГорбачевскийСергей Валерьевич

д-р мед. наук, проф., зав. отд-нием хирургического лечения заболеваний сердца с прогрессирующей легочной гипертензией, проф. каф. сердечно-сосудистой хирургии

svgorby@newmail.ruA.N.Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian FederationФГБУ «НМИЦ ССХ им. А.Н.Бакулева», ФГБОУ ДПО РМАНПОRussian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian FederationФГБУ «НМИЦ ССХ им. А.Н.Бакулева», ФГБОУ ДПО РМАНПОA.N.Bakulev National Medical Research Center of Cardiovascular Surgery of the Ministry of Health of the Russian FederationRussian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation15062018152VOL 15, NO2 (2018)ТОМ 15, №2 (2018)727609042020Copyright ©; 2018, Consilium MedicumCopyright ©; 2018, ООО "Консилиум Медикум"2018Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://journals.eco-vector.com/2075-082X/article/view/29613

Endogen nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) deficiency in pulmonary vessels walls plays essential role in pulmonary arterial hypertension (PAH) pathogenesis. Soluble guanylate cyclase stimulator riociguat and phosphodiesterase-5 (PDE5) inhibitor sildenafil increase cGMP content and have proven clinical efficacy in PAH treatment. The potentially beneficial mechanisms of riociguat mechanism of action include endogen NO independence in cGMP synthesis and its independence from other phosphodiesterase isoferments (other than PDE5). Clinical options, safety and effectiveness of iPDE5 - riociguat transition in patients with PAH were for the first time shown in non-controlled study RESPITE and the assessment is continued in randomized placebo-controlled trial REPLACE.

Недостаточное содержание эндогенного оксида азота и циклического гуанозинмонофосфата (цГМФ) в стенке легочных сосудов играет важную роль в патогенезе легочной артериальной гипертензии (ЛАГ). Стимулятор растворимой гуанилатциклазы риоцигуат и ингибитор фосфодиэстеразы-5 (иФДЭ-5) силденафил увеличивают содержание цГМФ и имеют доказанную клиническую эффективность при ЛАГ. Потенциально выгодными особенностями механизма действия риоцигуата являются независимость от эндогенного оксида азота при синтезе цГМФ и независимость от других (помимо ФДЭ-5) изоферментов фосфодиэстераз. Клиническая возможность, безопасность и эффективность замены иФДЭ-5 на риоцигуат у больных ЛАГ впервые показана в неконтролируемом исследовании RESPITE и продолжает оцениваться в рандомизированном плацебо-контролируемом исследовании REPLACE.

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