rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2013-9-4-448-454rpcardio-112Research ArticleCURRENT QUESTIONS OF CLINICAL PHARMACOLOGYАКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИNORVASC® IN RUSSIA 20 YEARS LATER: CONTINUATION OF THE HISTORYНОРВАСК® В РОССИИ 20 ЛЕТ СПУСТЯ: ПРОДОЛЖЕНИЕ ИСТОРИИРуденкоА. В.RudenkoA. V.

Кандидат медицинских наук, врач отдела радионуклидной диагностики и позитронно-эмиссионной томографии

doctorrudenko@inbox.ruРуденкоБ. А.RudenkoB. A.

Доктор медицинских наук, ведущий научный сотрудник лаборатории рентгенэндоваскулярных методов диагностики и лечения

doctorrudenko@inbox.ruРоссийский кардиологический научно-производственный комплекс, МоскваРоссияRussian Cardiology Research and Production Complex, MoscowRussian FederationГосударственный научно-исследовательский центр профилактической медицины, МоскваРоссияState Research Center for Preventive Medicin, MoscowRussian Federation20132209201594448454Copyright © Rudenko A.V., Rudenko B.A., 20152015Руденко А.В., Руденко Б.А.Rudenko A.V., Rudenko B.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/112

Amlodipine combines the most important clinical effects of calcium antagonists with minimal side effects of both its ATC class  and drugs of previous generations. Its high antihypertensive  activity is not in doubt. Proven ability to improve long-term prognosis is a priority when choosing of amlodipine for treatment of hypertensive patients. This is particularly important for the primary prevention in the presence of both risk factors and associated clinical conditions.  Amlodipine therapy significantly reduced cardiovascular events incidence in patients with atherosclerosis, even if they have no arterial hypertension. The likely rationales for this amlodipine effect are its vasoprotective properties, ability to re- duce vascular stiffness and to slow down the progression of atherosclerosis.

Амлодипин сочетает в себе наиболее значимые клинические эффекты антагонистов кальция с минимальной вероятностью побочных эффектов, характерных для этой группы в целом, а также для препаратов предыдущих поколений. Его высокая антигипертензивная активность не вызывает сомнения. Но при выборе амлодипина для лечения пациентов с артериальной гипертонией (АГ) бóльшее значение имеет его доказанная способность улучшать отдаленный прогноз. Это особенно важно при первичной профилактике, как при наличии факторов риска, так и при наличии ассоциированных клинических состояний. Применение амлодипина достоверно снижает частоту сердечно-сосудистых осложнений у пациентов с атеросклерозом даже при отсутствии у них АГ. Наиболее вероятное объяснение этих эффектов – вазопротективные свойства амлодипина, его способность уменьшать жесткость сосудистой стенки и замедлять прогрессирование атеросклероза.

амлодипинартериальная гипертониясердечно-сосудистые осложненияamlodipinearterial hypertensioncardiovascular complicationsReferencesFurberg C.D., Psaty B.M., Meyer J.V. Nifedipine. Dose-related increase in mortality in patients with coronary heart disease. Ciculation 1995; 92: 1326-1331.Furberg C.D., Psaty B.M., Meyer J.V. Nifedipine. Dose-related increase in mortality in patients with coronary heart disease. Ciculation 1995; 92: 1326-1331.Psaty B.M., Heckbert S.R., Koepsell T.D. et al. The risk of miocardial infarction associated with antihypertensive drug therapies. JAMA 1995; 274: 620-625.Psaty B.M., Heckbert S.R., Koepsell T.D. et al. The risk of miocardial infarction associated with antihypertensive drug therapies. JAMA 1995; 274: 620-625.Bangalore S., Steg G., Deedwania P. et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 2012;308(13):1340-9.Bangalore S., Steg G., Deedwania P. et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 2012;308(13):1340-9.Smith S.C. Jr., Benjamin E.J., Bonow R.O. et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 2011;124(22):2458.Smith S.C. Jr., Benjamin E.J., Bonow R.O. et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 2011;124(22):2458.Hamm C.W., Bassand J.P., Agewall S. et al. ESC Guidelines for the management of acute coronary syn- dromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment el- evation of the European Society of Cardiology (ESC). Eur Heart J 2011;32(23):2999Hamm C.W., Bassand J.P., Agewall S. et al. ESC Guidelines for the management of acute coronary syn- dromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment el- evation of the European Society of Cardiology (ESC). Eur Heart J 2011;32(23):2999Chahine R.A., Feldman R.L., Giles T.D. et al. Randomized placebo-controlled trial of amlodipine in vasospastic angina. Amlodipine Study 160 Group. J Am Coll Cardiol 1993; 21(6): 1365-70.Chahine R.A., Feldman R.L., Giles T.D. et al. Randomized placebo-controlled trial of amlodipine in vasospastic angina. Amlodipine Study 160 Group. J Am Coll Cardiol 1993; 21(6): 1365-70.Watanabe K., Izumi T., Miyakita Y. et al. Efficacy of amlodipine besilate therapy for variant angina: eval- uation by 24-hour Holter monitoring. Cardiovasc Drugs Ther 1993;7(6): 923-928.Watanabe K., Izumi T., Miyakita Y. et al. Efficacy of amlodipine besilate therapy for variant angina: eval- uation by 24-hour Holter monitoring. Cardiovasc Drugs Ther 1993;7(6): 923-928.Sidorenko B.A, Preobrazhenskiy D.V. Calcium channel blockers. Moscow: Informatik; 1997. Russian (СидоренкоБ.А, Преображенский Д.В. Антагонисты кальция. М.: Информатик; 1997).Sidorenko B.A, Preobrazhenskiy D.V. Calcium channel blockers. Moscow: Informatik; 1997. Russian (СидоренкоБ.А, Преображенский Д.В. Антагонисты кальция. М.: Информатик; 1997).Nayler W.G. Amlodipine. Berlin: Springer-Verlag; 1993.Nayler W.G. Amlodipine. Berlin: Springer-Verlag; 1993.Preobrazhenskiy D.V., Sidorenko B.A., Shabaeva E.N. Amlodipine – a calcium channel blocker of the third generation. Kardiologiia 1998; (2): 66-73. Russian (Преображенский Д.В., Сидоренко Б.А., Шабаева Е.Н. Амлодипин – антагонист кальция третьего поколения. Кардиология 1998; (2): 66-73).Preobrazhenskiy D.V., Sidorenko B.A., Shabaeva E.N. Amlodipine – a calcium channel blocker of the third generation. Kardiologiia 1998; (2): 66-73. Russian (Преображенский Д.В., Сидоренко Б.А., Шабаева Е.Н. Амлодипин – антагонист кальция третьего поколения. Кардиология 1998; (2): 66-73).Deanfield J., Detry J., Sellier P. et al. Medical treatment of myocardial ischemia in coronary heart disease: Effect of drug regimen and irregular dosing in CAPE II trial. JACC 2002; 40 (5): 917-925.Deanfield J., Detry J., Sellier P. et al. Medical treatment of myocardial ischemia in coronary heart disease: Effect of drug regimen and irregular dosing in CAPE II trial. JACC 2002; 40 (5): 917-925.Davis R.F., Habibi H., Klinke W.P. et al. Effect of amlodipine, atenolol and their combination on myocardial ischemia during treadmill exercise and ambulatory monitoring. JACC 1995; 25: 619-625.Davis R.F., Habibi H., Klinke W.P. et al. Effect of amlodipine, atenolol and their combination on myocardial ischemia during treadmill exercise and ambulatory monitoring. JACC 1995; 25: 619-625.Koren MJ, Hunninghake DB; ALLIANCE Investigators. Clinical Outcomes in Managed-Care Patients With Coronary Heart Disease Treated Aggressively in Lipid-Lowering Disease Management Clinics The ALLIANCE Study. J Am Coll Cardiol 2004; 44: 1772-1779.Koren MJ, Hunninghake DB; ALLIANCE Investigators. Clinical Outcomes in Managed-Care Patients With Coronary Heart Disease Treated Aggressively in Lipid-Lowering Disease Management Clinics The ALLIANCE Study. J Am Coll Cardiol 2004; 44: 1772-1779.LaRosa J.C, Grundy S.M., Waters D.D. et al. Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease. N Engl J Med. 2005; 352:1425-35.LaRosa J.C, Grundy S.M., Waters D.D. et al. Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease. N Engl J Med. 2005; 352:1425-35.Cannon C.P., Braunwald E., McCabe C.H., et al., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. N Eng J Med 2004; 350: 1495-1504.Cannon C.P., Braunwald E., McCabe C.H., et al., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. N Eng J Med 2004; 350: 1495-1504.Mancini G. B. J., Miller M. E., Evans G. W. et al. Post hoc analysis of coronary findings from the Prospective Randomized Evaluation of the Vascular Effects of the Norvasc Trial (PREVENT). Am J Cardiol 2002; 89 (12): 1414-1416.Mancini G. B. J., Miller M. E., Evans G. W. et al. Post hoc analysis of coronary findings from the Prospective Randomized Evaluation of the Vascular Effects of the Norvasc Trial (PREVENT). Am J Cardiol 2002; 89 (12): 1414-1416.Jorgensen B., Thaulow E. Effects of amlodipine on ischemia after percutaneuos transluminal coronary angioplasty: Secondary results of the Coronary Angioplasty Amlodipine Restenosis (CAPARES) study. Am Heart J 2003; 145: 1030-1035.Jorgensen B., Thaulow E. Effects of amlodipine on ischemia after percutaneuos transluminal coronary angioplasty: Secondary results of the Coronary Angioplasty Amlodipine Restenosis (CAPARES) study. Am Heart J 2003; 145: 1030-1035.Toyo-Oka T., Nayler W.G. Third generation calcium entry blockers. Blood Pressure 1996; 5: 206-208.Toyo-Oka T., Nayler W.G. Third generation calcium entry blockers. Blood Pressure 1996; 5: 206-208.Epstein M. Role of a third generation calcium antagonists in the management of hypertension. - Drugs, 1999; 57 (suppl. 1): 1-10.Epstein M. Role of a third generation calcium antagonists in the management of hypertension. - Drugs, 1999; 57 (suppl. 1): 1-10.Neaton J.D., Grimm R.H., Prineas R.J et al. Treatment of Mild Hypertension Study: final results - JAMA, 1993; 270: 713-724.Neaton J.D., Grimm R.H., Prineas R.J et al. Treatment of Mild Hypertension Study: final results - JAMA, 1993; 270: 713-724.Williams B. VALUE and supremacy of blood pressure control for cardiovascular protection Journal of Hypertension 2004, 22:1435-1437Williams B. VALUE and supremacy of blood pressure control for cardiovascular protection Journal of Hypertension 2004, 22:1435-1437Julius S., Kjeldsen S. E., Weber Michae., et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial THE LANCET , 2004; 363: 2022-2031.Julius S., Kjeldsen S. E., Weber Michae., et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial THE LANCET , 2004; 363: 2022-2031.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 block- er vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALL- HAT). JAMA. 2002; 288: 2981-2997.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 block- er vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALL- HAT). JAMA. 2002; 288: 2981-2997.Dahlof B., Sever P. S., Poulter N. R. et al. Prevention of cardiovascular events with an Antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendrofluazide as required, in Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial. – Lancet, 2005; 366: 895-906.Dahlof B., Sever P. S., Poulter N. R. et al. Prevention of cardiovascular events with an Antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendrofluazide as required, in Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial. – Lancet, 2005; 366: 895-906.Collier D., Hughes A.D., Thurston H. et al. Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes. Principal Results of the Conduit Artery Function Evaluation (CAFE) Study. Circulation 2006; 113: 1-13.)Collier D., Hughes A.D., Thurston H. et al. Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes. Principal Results of the Conduit Artery Function Evaluation (CAFE) Study. Circulation 2006; 113: 1-13.)Sever P. S., Dahlof B., Poultier N. R. et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): multicentre randomised controlled trial. Lancet 2003; 361: 1149-1158.Sever P. S., Dahlof B., Poultier N. R. et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): multicentre randomised controlled trial. Lancet 2003; 361: 1149-1158.Sever P. S., Dahlof B., Poultier N. R. et al. Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial. Eur Heart J 2006; 27: 2982-2988.Sever P. S., Dahlof B., Poultier N. R. et al. Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial. Eur Heart J 2006; 27: 2982-2988.Nissen S., Tuzcu E., Libby P. et al. Effects of antihypertensive drugs on cardiovascular events in patients with coronary heart disease and normal blood pressure. Randomized controlled CAMELOT study. JAMA 2004; 292 (18): 2217-2226.Nissen S., Tuzcu E., Libby P. et al. Effects of antihypertensive drugs on cardiovascular events in patients with coronary heart disease and normal blood pressure. Randomized controlled CAMELOT study. JAMA 2004; 292 (18): 2217-2226.Phillips J.E., Mason R.P. Inhibition of oxidized LDL aggregation with the calcium channel blocker am-odipine: role of electrostatic interactions. Atherosclerois 168 (2003) 239-244.Phillips J.E., Mason R.P. Inhibition of oxidized LDL aggregation with the calcium channel blocker am-odipine: role of electrostatic interactions. Atherosclerois 168 (2003) 239-244.Mason R.P., Marche P., Hintze T.H. Novel vascular biology of third-generation L-type calcium channel antagonists: ancillary actions of amlodipine. Arterioscler Thromb Vasc Biol. 2003; 23: 2155-63,Mason R.P., Marche P., Hintze T.H. Novel vascular biology of third-generation L-type calcium channel antagonists: ancillary actions of amlodipine. Arterioscler Thromb Vasc Biol. 2003; 23: 2155-63,Packer M, O’Connor M, Ghali JK, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group. N Engl J Med 1996; 335: 1107-1114.Packer M, O’Connor M, Ghali JK, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group. N Engl J Med 1996; 335: 1107-1114.

The authors declare that there are no conflicts of interest present.