Vol 6, No 4 (2009)

В публикации представлен современный взгляд на возможности различных ƒ-блокаторов в клинической ситуации. Класс ƒ-блокато- ров представляет неоднородную группу в плане возможностей клинического использования. Появляющаяся в последнее время кри- тика ƒ-блокаторов отдельными исследователями не должна вводить в заблуждение практического врача, который всегда должен задавать себе вопрос, о каких ƒ-блокаторах идет речь. Действительно, ряд ƒ-блокаторов, особенно неселективных, обладает отри- цательными эффектами и в ряде клинических ситуаций не может быть использован (метаболические нарушения, хроническая обструктивная болезнь легких (ХОБЛ), периферический атеросклероз). Вместе с тем современные суперселективные ƒ-блокаторы не обладают указанными отрицательными эффектами и могут широко использоваться в клинической практике, в том числе при метаболическом синдроме, сахарном диабете, ХОБЛ, периферическом атеросклерозе.

Blockade of renin-angiotensin systems is one problem in the treatment of arterial hypertension. Resistant hypertension and patients with high cardiovascular risk demand frequently use of combination therapy. The efficiency of combined therapy losartan plus hydrochlorothiazide at patients with arterial hypertension was studied in several large clinical multicentre randomized studies. It is proved high efficiency and safety of this combination therapy.

Unlike first-line antihypertensives, nebivolol, a cardioselective b-blocker with vasodilatatory properties caused by its ability to modulate the activity of nitric oxide, positively affects prognosis in patients with arterial hypertension and chronic heart failure and shows metabolic neutrality. The clinical and pathogenetic studies demonstrating the benefits of nebivolol are discussed. Keywords: nebivolol, arterial hypertension, b-blockers.

Angiotensin II (ATII) receptor antagonists, the drugs that affect the basic links of neuro-humoral regulation: the renin-angiotensin-aldosterone (RAAS) and sympathicoadrenal systems, have currently found wide use in clinical cardiology. By blocking the specific ATII receptors, the agents of this group contributes to systemic vasodilation, cell growth inhibition, including to the suppressed proliferation of endothelial and smooth muscle cells of the vascular wall, fibro-blasts, and to the inhibited cardiomyocytic hypertrophy. ATII receptor antagonists are referred to as first-line drugs used in the treatment of arterial hypertension (AH) in young patients in whom RAAS activity is generally increased, in that of diabetes mellitus since the drugs of this group are able to reduce the degree of microalbuminuria/proteinuria, and in the complex therapy for chronic heart failure (CHF). One of the representatives of this group is valsartan, a non-heterocyclic derivative, has a double elimination pathway (the liver and kidneys), a sustained 24-hour antihypertensive effect after single administration, which allows its once-daily dosing, by correcting systolic and diastolic blood pressure in more than 70% of patients. It should be emphasized that adjustment of the dose of valsartan is not required in moderately diminished hepatic or renal function. Valsartan failed to exert a negative effect on the level of glycemia and to cause changes in lipid profile and triglyceride levels. The long-term use of valsartan as mono-therapy for AH requires that the safety of treatment should not undergo additional laboratory monitoring. A multicenter, double-blind, placebo-controlled Val-HeFT trial covering 5010 pa-tients with CHF and a left ventricular ejection fraction (EF) of less than 40%, demonstrated that valsartan produced good clinical effects. Although overall mortality (one of the primary end points) was similar in the valsartan and placebo groups; another end point (reductions in the risk of mortality and morbidity) and the frequency of hospitalizations for increased symptoms of CHF was decreased in the valsartan group by 13.2 and 27.5%; respectively. In addition, valsar-tan was found to have a positive effect on a number of secondary end points: quality of life sig-nificantly improved, EF of the left ventricle rose, its dimensions decreased, and the degree of CHF symptoms was reduced, exercise tolerance increased, and the plasma levels of norepineph-rine, atrial natriuretic peptide, and aldosterone were decreased. The adverse reactions caused by ATII antagonists are seen rather rarely, which provides high patient compliance to some extent. The contraindications to the use of ATII antagonists are their hypersensitivity, arterial hypotension, hyperkalemia, dehydration, bilateral renal artery stenosis, pregnancy, childhood.

The treatment of ACE inhibitors reduce risk of cardiovascular morbidity and mortality. The patients with grade 1-2 hypertension (n=2060) and at least one additional risk factors, subclinical organ damage, established CV or renal disease, diabetes mellitus or metabolic syndrome are recruited in this clinical study. The article presented of study design.

Aim: to evaluate memory, attention and thinking functions indices in young hired military officers depending on their 24-hours blood pressure profiles. Materials and methods. The study was made in 49 patients with stage 1-2 arterial hypertension, aged 39,3±0,8, who did not take hypotensive medicines or took them occasionally. 24-hours blood pressure monitoring was performed with assessment of cognitive functions (memory, attention) depending on the stage, degree and duration of the disease. The control group included 12 men with no signs of arterial hypertension. Results. Comparing with the controls the memory, attention and thinking indices in hypertonic patients were found to be lower .even in those who had the first degree of hypertension and duration of the disease less than 5 years. The hypertonic patients showed lowering of attention and semantic memory scopes irrespective of duration of the disease. There was a negative correlation between monitored blood pressure data and memory, attention and thinking indices. Conclusions. Light cognitive dysfunctions can be found in young hired military officers with initial arterial hypertension but they are more typical for stage 2 of the disease

Arterial hypertension is one of the most important risk factors of acute cerebral circulatory disorders. Many clinical studies indicate that there are mechanisms that permit the prevention of stroke irrespective of a direct reduction in blood pressure. Antihypertensive agents affecting the renin-angiotensin-aldosterone system may have a cerebral protective effect beyond blood pres-sure lowering. The ability of angiotensin II receptor antagonists to prevent the development of stroke is associated with the fact that with the use of these agents, angiotensin II interacts with AT2-receptors, thereby improving the blood flow in the brain and enhancing the neuronal resis-tance to hypoxia. In this review, the focus is on the capacity of the angiotensin II receptor an-tagonist candesartan to prevent severe cerebrovascular events.