rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2017-13-6-851-855rpcardio-1578Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯFEATURES OF MANAGEMENT OF PATIENTS WITH HYPERTENSION IN COMBINATION WITH ISCHEMIC HEART DISEASE: MODERN APPROACHESОСОБЕННОСТИ ВЕДЕНИЯ ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ В СОЧЕТАНИИ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА: СОВРЕМЕННЫЕ ПОДХОДЫНапалковД. А.NapalkovD. А.

Напалков Дмитрий Александрович – доктор медицинских наук, профессор, кафедра факультетской терапии №1 лечебного факультета 

119991, Москва, ул. Трубецкая, 8 стр. 2

Dmitry A. Napalkov – MD, PhD, Professor, Chair of Faculty Therapy №1, Medical Faculty 

Trubetskaya ul. 8, Moscow, 119991

dminap@mail.ruСоколоваА. А.SokolovaA. A.

Соколова Анастасия Андреевна – кандидат медицинских наук, ассистент, кафедра факультетской терапии №1 лечебного факультета 

119991, Москва, ул. Трубецкая, 8 стр. 2

Anastasiya A. Sokolova – MD, PhD, Assistant, Chair of Faculty Therapy №1, Medical Faculty 

Trubetskaya ul. 8, Moscow, 119991

Первый Московский государственный медицинский университет им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian Federation201728122017136851855Copyright © Napalkov D.А., Sokolova A.A., 20172017Напалков Д.А., Соколова А.А.Napalkov D.А., Sokolova A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1578

The main positions of the American guidelines on management of patients with hypertension and concomitant ischemic heart disease (2015) are discussed in the article. Questions about the target blood pressure levels and the choice of the main classes of antihypertensive drugs, depending on the history of myocardial infarction, diabetes mellitus, and chronic kidney disease are presented. The principles of management of hypertensive patients with stable angina and acute coronary syndrome are discussed separately. The place of amlodipine in the therapy of patients with hypertension and ischemic heart disease is also being considered. Analysis of the large number of patients presented in the VALUE, CAMELOT and PREVENT studies allows one to more reliably talk about the pleiotropic effects of amlodipine and to determine its place in the antihypertensive therapy of patients with subclinical and symptomatic atherosclerosis. Possible potentiating effect of angiotensin converting enzyme inhibitors and amlodipine is also discussed in the article. This allows us to consider amlodipine as one of the key components of antihypertensive therapy in patients with ischemic heart disease, which contributes not only to accelerated normalization of blood pressure but also to a decrease in cardiovascular risk.

В статье обсуждаются основные позиции американских рекомендаций 2015 г. по ведению пациентов с артериальной гипертензией (АГ) и сопутствующей ишемической болезнью сердца (ИБС). Детализированы вопросы, касающиеся целевых цифр артериального давления (АД) и выбора основных классов антигипертензивных препаратов в зависимости от наличия в анамнезе перенесенного инфаркта миокарда, сахарного диабета, хронической болезни почек. Отдельно обсуждены принципы ведения пациентов с АГ при стабильной стенокардии и остром коронарном синдроме. Также рассматривается место амлодипина в терапии пациентов с АГ и ИБС. Анализ большого числа пациентов, представленных в исследованиях VALUE, CAMELOT и PREVENT, позволяет с большей достоверностью говорить о плейотропных эффектах амлодипина, и определить его место в антигипертензивной терапии пациентов с субклиническим и клинически значимым атеросклерозом. В статье также обсуждается возможный потенцирующий эффект ингибиторов ангиотензинпревращающего фермента и амлодипина, что позволяет рассматривать последний в качестве одного из ключевых компонентов антигипертензивной терапии у пациентов с ИБС, способствующего не только ускоренной нормализации АД, но и приводящего к снижению сердечно-сосудистого риска.

артериальная гипертензияишемическая болезнь сердцаблокаторы кальциевых каналовамлодипинhypertensionischemic heart diseasecalcium channel blockersamlodipineReferencesFranklin S.S., Larson M.G., Khan S.A., et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation. 2001;103:1245-9. doi: 10.1161/01.CIR.103.9.1245.Franklin S.S., Larson M.G., Khan S.A., et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation. 2001;103:1245-9. doi: 10.1161/01.CIR.103.9.1245.Neaton J.D., Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Int Med. 1992;152:56-64. doi: 10.1001/archinte.1992.00400130082009.Neaton J.D., Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Int Med. 1992;152:56-64. doi: 10.1001/archinte.1992.00400130082009.Rosendorff C., Lackland D.T., Allison M., et al., on behalf of the American Heart Association, American College of Cardiology, and American Society of Hypertension. // Treatment of Hypertension in Patients With Coronary Artery Disease. Hypertension. 2015;65:1372-407. doi: 10.1161/HYP.0000000000000018.Rosendorff C., Lackland D.T., Allison M., et al., on behalf of the American Heart Association, American College of Cardiology, and American Society of Hypertension. // Treatment of Hypertension in Patients With Coronary Artery Disease. Hypertension. 2015;65:1372-407. doi: 10.1161/HYP.0000000000000018.Nissen S.E., Tuzcu E.M., Libby P., et al., CAMELOT Investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT Study: a randomized controlled trial. JAMA. 2004;292:2217-25. doi:10.1001/jama.292.18.2217.Nissen S.E., Tuzcu E.M., Libby P., et al., CAMELOT Investigators. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT Study: a randomized controlled trial. JAMA. 2004;292:2217-25. doi:10.1001/jama.292.18.2217.Rosendorff C. Calcium antagonists in the treatment of hypertension in patients with ischaemic heart disease. Expert Opin Pharmacother. 2003;4:1535-41. doi:10.1517/14656566.4.9.1535.Rosendorff C. Calcium antagonists in the treatment of hypertension in patients with ischaemic heart disease. Expert Opin Pharmacother. 2003;4:1535-41. doi:10.1517/14656566.4.9.1535.Mason RP. Mechanisms of plaque stabilization for the dihydropyridine calcium channel blocker amlodipine: review of the evidence. Atherosclerosis. 2002; 165: 191-9. doi: 10.1016/S00219150(01)00729-8.Mason RP. Mechanisms of plaque stabilization for the dihydropyridine calcium channel blocker amlodipine: review of the evidence. Atherosclerosis. 2002; 165: 191-9. doi: 10.1016/S00219150(01)00729-8.Park S., Yan P., Cerezo C., Jeffers B.W. Effect of visit-to-visit blood pressure variability on cardiovascular events in patients with coronary artery disease and well-controlled blood pressure. J Am Soc Hypertens. 2016;10(10):799-810. doi:10.1016/j.jash.2016.08.004.Park S., Yan P., Cerezo C., Jeffers B.W. Effect of visit-to-visit blood pressure variability on cardiovascular events in patients with coronary artery disease and well-controlled blood pressure. J Am Soc Hypertens. 2016;10(10):799-810. doi:10.1016/j.jash.2016.08.004.Julius S., Kjeldsen S.E., Weber M., et al., VALUE Trial Group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004;363(9426):2022-31. doi: 10.1016/S0140-6736(04)16451-9.Julius S., Kjeldsen S.E., Weber M., et al., VALUE Trial Group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004;363(9426):2022-31. doi: 10.1016/S0140-6736(04)16451-9.Turnbull F. Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blood pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet. 2003;362:1527-35. doi: 10.1016/S0140-6736(03)14739-3.Turnbull F. Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different blood pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet. 2003;362:1527-35. doi: 10.1016/S0140-6736(03)14739-3.Wang J.G., Li Y., Franklin S.S., Safar M. Prevention of stroke and myocardial infarction by amlodipine and angiotensin receptor blockers. Hypertension. 2007;50:181-8. doi:10.1161/HYPERTENSIONAHA.107.089763Wang J.G., Li Y., Franklin S.S., Safar M. Prevention of stroke and myocardial infarction by amlodipine and angiotensin receptor blockers. Hypertension. 2007;50:181-8. doi:10.1161/HYPERTENSIONAHA.107.089763Lee S.A., Choi H.M., Park H.J., et al. Amlodipine and cardiovascular outcomes in hypertensive patients: meta-analysis comparing amlodipine-based versus other antihypertensive therapy. Korean J Intern Med. 2014;29:315-324. doi:10.3904/kjim.2014.29.3.315.Lee S.A., Choi H.M., Park H.J., et al. Amlodipine and cardiovascular outcomes in hypertensive patients: meta-analysis comparing amlodipine-based versus other antihypertensive therapy. Korean J Intern Med. 2014;29:315-324. doi:10.3904/kjim.2014.29.3.315.Vlachopoulos C. Combination therapy in hypertension: from effects on arterial stiffness and central haemodynamics to cardiovascular benefits. Artery Research. 2016;14:27-35. doi: 10.1016/j.ijcard.2016.11.149.Vlachopoulos C. Combination therapy in hypertension: from effects on arterial stiffness and central haemodynamics to cardiovascular benefits. Artery Research. 2016;14:27-35. doi: 10.1016/j.ijcard.2016.11.149.Bertrand M.E., Vlachopoulos C., Mourad J.J. Triple combination therapy for global cardiovascular risk: atorvastatin, perindopril and amlodipine. Am J Cardiovasc Drugs. 2016;16(4):241-253. doi 10.1007/s40256-016-0175-2.Bertrand M.E., Vlachopoulos C., Mourad J.J. Triple combination therapy for global cardiovascular risk: atorvastatin, perindopril and amlodipine. Am J Cardiovasc Drugs. 2016;16(4):241-253. doi 10.1007/s40256-016-0175-2.Bakris G., Briasoulis A., Dahlof B., et al., for the ACCOMPLISH Investigators. Comparison of Benazepril Plus Amlodipine or Hydrochlorothiazide in High-Risk Patients With Hypertension and Coronary Artery Disease. Am J Cardiol. 2013;112:255-9. doi: 10.1016/j.amjcard.2013.03.026.Bakris G., Briasoulis A., Dahlof B., et al., for the ACCOMPLISH Investigators. Comparison of Benazepril Plus Amlodipine or Hydrochlorothiazide in High-Risk Patients With Hypertension and Coronary Artery Disease. Am J Cardiol. 2013;112:255-9. doi: 10.1016/j.amjcard.2013.03.026.

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