Author/Editor     Bombek, Mirko
Title     Ali z izbiro antihipertenzivnega zdravljenja lahko upočasnimo razvoj srčnožilnih bolezni in njihovih posledic?
Translated title     Are we able to slow down the progress of cardiovascular diseases and their fatal events with proper choice of antihipertensive treatment?
Type     članek
Source     In: Hojs R, editor. Zbornik prispevkov 20. srečanje internistov in zdravnikov družinske medicine "Iz prakse za prakso" ; 2009 maj 8-9; Maribor. Maribor: Univerzitetni klinični center,
Publication year     2009
Volume     str. 13-20
Language     slo
Abstract     It is still much debate over the optimal management of hypertension. The ALLHAT study and large meta-analyses have shown no major differences in cardiovascular outcome among three major classes of antihypertensive drugs - diuretics, calcium antagonists and ACE inhibitors. Most experts have agreed that blood pressure reduction matters more than the choice of antihypertensive agent. However, recently published data for hypertensive patients at moderate risk of cardiac events have caused some experts to re-evaluate this view. In the ASCOT-BPLA trial, antihypertensive therapy based on amlodipine and perindopril significantly reduced total and cardiovascular mortality as well as other clinically relevant outcomes in comparison with a traditional strategy based on atenolol and a thiazide diuretic. These findings suggest that amlodipinelperindopril may exert a beneficial effect by acting on other parameters such as central blood pressure(CAFE trial) or tissue perfision or has other pleiotropic effects. ACE inhibitors alone (EUROPA, PERTINENT trials) have been shown to have antiatherosclerotic and antithrombogenic effects, to improve endothelial dysfunction, and to prevent vascular and cardiac remodeling. In this regard, perindopril, which has high affinity for tissue ACE and true 24-hour duration of action, is one of the most extensively studied ACE inhibitor. ACE inhibitors reduce arterial stiffness, an independent risk factor for cardiovascular events, and have a beneficial effect on central aortic blood pressure and tissue perfusion thus providing a possible explanation for the findings of several trials and confirming that ACE inhibitors are an appropriate first choice for patients with hypertension and risk of cardiovascular events.
Summary     Optimalno zdravljenje arterijske hipertenzije je še vedno predmet razprav. Raziskava ALLHAT in velike metaanalize sprva niso pokazale večjih razlik v številu srčnožilnih dogodkov med tremi razredi antihipertenzivnih zdravil - diuretiki, zaviralci kalcijevih kanalov in zaviralci ACE. Večina strokovnjakov je menila, da je samo znižanje tlaka pomembnejše od izbire zdravil. Novi podatki pri hipertoničnih bolnikih z zmernim tveganjem za srčnožilne dogodke so to mnenje spremenili. V raziskavi ASCOT-BPLA je antihipertenzivno zdravljenje z amlodipinom in perindoprilom pomembno znižalo skupno in srčnožilno umrljivost, prav tako druge klinično pomembne izide v primerjavi s starejšim načinom zdravljenja z atenololom in tiazidnim diuretikom. Ti izidi nas prepričujejo, da zaviralci kalcijevih kanalov /zaviralci ACE ugodno vplivajo tudi na druge dejavnike kot so centralni krvni tlak v aorti (raziskava CAFE), prekrvljenost tkiv ali imajo druge pleiotropne učinke. Sami zaviralci ACE (raziskava EUROPA, PERTINENT) dokazano učinkujejo antiaterosklerotično, antitrombogeno, izboljšajo endotelno disfunkcijo in preprečijo preoblikovanje žil in srca. Tako je perindopril, z visoko specifičnostjo za tkivno konvertazo in dolgim 24-urnim delovanjem, eden najbolje raziskanih zaviralcev konvertaze. Zaviralci ACE zmanjšajo togost arterij, neodvisen dejavnik tveganja za srčnožilne dogodke, s tem imajo ugoden učinek na centralni krvni tlak v aorti, izboljšajo tudi prekrvavitev tkiv, s čimer lahko razložimo njihove ugodne učinke v več raziskavah in potrdimo, da so zaviralci ACE primerna prva izbira za zdravljenje ogroženih bolnikov s hipertenzijo, s katem lahko upočasnimo razvoj srčnožilnih bolezni in njihovih posledic.
Descriptors     HYPERTENSION
BLOOD PRESSURE
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
CARDIOVASCULAR DISEASES