Systemic HypertensionSystemic HypertensionСистемные гипертензии2075-082X2542-2189Intermedservice Ltd3306510.26442/SG33065ArticlesСтатьиDiuretics in treatment of patients with arterial hypertensionДиуретики в лечении больных артериальной гипертониейChazovaIrina Evgen'evnaЧазоваИрина Евгеньевна

д-р мед. наук, проф., руководитель отдела системных гипертензий ИКК им. А.Л. Мясникова ФГУ РКНПКМинзравсоцразвития. Контактный телефон: 414-63-05; ФГУ Российский кардиологический научно-производственный комплекс, Москва

RatovaLyudmila GennadievnaРатоваЛюдмила Геннадиевна

канд. мед. наук, сотр. отд. системных гипертензий ИКК им. А.Л. Мясникова.Контактный телефон: 414-61-86; ФГУ Российский кардиологический научно-производственный комплекс, Москва

lratova@mail.ruФГУ Российский кардиологический научно-производственный комплекс, Москва1512200964NO4 (2009)ТОМ 6, №4 (2009)91213042020Copyright ©; 2009, Consilium MedicumCopyright ©; 2009, ООО "Консилиум Медикум"2009Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://journals.eco-vector.com/2075-082X/article/view/33065

Since all cardiovascular risk factors contribute to coronary artery disease in patients with arterial hypertension, they should all be considered in the management of this disease process. Thiazides diuretics when used at high doses, negatively impact lipid and glucose metabolism. These findings have resulted in decreased use of diuretics in favor of newer agents such as ACE inhibitors and calcium antagonists. However, recent data have demonstrated that when used at low doses (6.25 or 25 mg of hydrochlorothiazide), diuretics lack significant metabolic side effects while bringing about significant reductions in blood pressure. Thus, at these doses, hydrochlorothiazide is a useful drug in the treatment of hypertension, both as monotherapy and in combination therapy.

Все сердечно-сосудистые факторы риска приводят к увеличению риска развития ишемической болезни сердца у пациентов с артериальной гипертонией, и их нужно учитывать при назначении лечения. Тиазидные диуретики в больших дозах негативно влияют на состояние липидного и углеводного обмена. Это обстоятельство привело к уменьшению назначения тиазидных диуретиков и более частому использованию «новых препаратов», таких как ингибиторы ангиотензинпревращающего фермента и антагонисты кальция. Однако недавние исследования продемонстрировали, что использование низких доз тиазидных диуретиков (6,25-25 мг гидрохлоротиазида) позволяет значительно снизить артериальное давление без существенных изменений со стороны метаболических показателей. Таким образом, низкие дозы гидрохлоротиазида эффективно и безопасно снижают артериальное давление при назначении как в виде моно-, так и комбинированной терапии.

arterial hypertensionthiazides diureticshydrochlorothiazideартериальная гипертензиятиазидные диуретикигидрохлоротиазид1. Леонова М.В., Белоусов Д.Ю., Штейнберг Л.Л. и др. Анализ врачебной практики проведения антигипертензивной терапии в России (по данным исследования Пифагор III). Фарматека. 2009; 12 (186): 114-9.2. Диагностика и лечение артериальной гипертензии. Российские рекомендации. Кардиоваск. тер. и профил. Прил. 2. 2008; 7 (6).3. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 1967; 202 (11): 1028-34.4. Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA 1970; 213 (7): 1143-52.5. Hansson L, Dahlof В, Ekbom T et al. Prognostic factors in the treatment of mild hypertension. The Management Committee of the Australian National Blood Pressure Study. Circulation 1984; 69: 668-76.6. Psaty BM, Smith NS, Siscovick DS et al. Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA 1997; 277: 739-45.7. Fletcher A, Amery A, Birkenhager W et al. Risks and benefits in the trial of the European Working Party on High Blood Pressure in the Elderly. J Hypertens 1991; 9 (3): 225-30.8. Hansson L, Dahlof B, Ekbom T et al. Key learnings from the STOP-Hypertension study: an update on the progress of the ongoing Swedish study of antihypertensive treatment in the elderly. Cardiovasc Drugs Ther 1991; 4 (Suppl. 6): 1253-5.9. Psaty B, Lumley T, Furberg C. Health outcomes associated with various antihypertensive therapies used as first-line agents. JAMA 2003; 289: 2534-44.10. Medical research council working party. Medical research council trial to treatment of hypertension in older adults: principal results. BMJ 1992; 304: 405-12.11. Neaton JD, Grimm RHJr, Prineas RJ et al. Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA 1993; 270: 713-24.12. 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: 2981-97.13. Hansson L, Lindholm LH, Niskanen L et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomized trial. Lancet 1999; 353: 611-6.14. Hansson L, Lindholm LH, Ekbom T et al. Randomized trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999; 354: 1751-6.15. Hansson L, Hedner T, Lund-Johansen P et al. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356: 359-65.16. Dahlоf 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: 995-1003.17. Sever PS, Dahof B. American College of Cardiology 2005 Scientific Sessions; March 6-9, 2005. Orlando, 2005.18. Gress TW, Nieto FJ, Shahar E et al. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes. N Engl J Med 2000; 342: 905-12.19. Blood Pressure Lowering Treatment Trialists\' Collaboration; Turnbull F, Neal B, Algert C et al. Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 2005; 165: 1410-9.20. Moser M. Diuretics should continue to be one of the preferred initial therapies in the management of hypertension: the argument for. J Clin Hypertens (Greenwich) 2005; 7 (2): 111-6.21. Papademetriou V, Burris JF, Notargiacomo A et al. Thiazide therapy is not a cause of arrhythmia in patients with systemic hypertension. Arch Intern Med 1988; 148: 1272-6.22. Spence JD, Huff M, Barnett PA. Effects of indapamide versus hydrochlorothiazide on plasma lipids and lipoproteins in hypertensive patients: a direct comparison. Can J Clin Pharmacol 2000; 7 (1): 32-7.23. Krum H, Skiba M, Gilbert RE. Comparative metabolic effects of hydrochlorothiazide and indapamide in hypertensive diabetic patients receiving ACE inhibitor therapy. Diabet Med 2003; 20 (9): 708-12.24. Wasnich R, Davis J, He Y et al. A randomized, double-masked, placebo-controlled trial of chlorthalidone and bone loss in elderly women. Osteoporos Int 1995; 5 (4): 247-51.25. Reid IR, Ames RW, Orr-Walker BJ et al. Hydrochlorothiazide Reduces loss of Cortical Bone in Normal Postmenopausal Women: A Randomized Controlled Trial. Am J Med 2000; 109: 362-70.26. LaCroix AZ, Ott SM, Ichikawa L et al. Low-dose hydrochlorothiazide and preservation of bone mineral density in older adults: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2000; l33: 516-26.27. Schoofs MW, van der Klift M, Hofman A et al. Thiazide diuretics and the risk for hip fracture. Ann Intern Med 2003; 139: 476-82.