medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-4-50-58medsovet-5604Research ArticleКАРДИОЛОГИЯCARDIOLOGYЭффективность (преимущества) рамиприла при артериальной гипертонии и сахарном диабете с позиции доказательной медициныEfficiency (advantages) of ramipril in arterial hypertension and diabetes mellitus from the point of view of evidence-based medicineЛеоноваМ. В.LeonovaM. V.

Леонова Марина Васильевна – доктор медицинских наук, профессор, член-корреспондент РАЕН, клинический фармаколог, член межрегиональной общественной организации «Ассоциация клинических фармакологов России».

400131, Волгоград, площадь Павших Борцов, д. 1.

Marina V. Leonova - Dr. of Sci. (Med.), professor, Corresponding Member of the Russian Academy of Natural Sciences, clinical pharmacologist, Member of the Interregional Public Organization “Association of Clinical Pharmacologists” of Russia.

1, Ploshchad Pavshikh Bortsov, Volgograd, 400131.

anti23@mail.ruАссоциация клинических фармакологов РоссииРоссияAssociation for Clinical PharmacologyRussian Federation202021052020045058Copyright © Леонова М.В., 20202020Леонова М.В.Leonova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5604

АГ и сахарный диабет являются коморбидными заболеваниями, взаимосвязаны общими патофизиологическими механизмами развития, сходными сердечно-сосудистыми осложнениями. Наличие тесной взаимосвязи между АГ и сахарным диабетом обусловлено значимостью активации ренин-ангиотензин-альдостероновой системы, которая лежит в основе ремоделирования сердечно-сосудистой системы и развития осложнений. Согласно современным клиническим рекомендациям ингибиторы АПФ являются препаратами выбора при лечении АГ в сочетании с сахарным диабетом. Применение ингибиторов АПФ у пациентов с АГ и диабетом сопровождается снижением относительного риска сердечно-сосудистых исходов и смертности. Представлен научный обзор крупных клинических исследований с результатами эффективности ингибитора АПФ рамиприла у пациентов с АГ и сахарным диабетом. Рамиприл обладает высокой аффинностью к ферментам АПФ-1 и кининазе II, выраженными клиническими и органопротективными эффектами, доказанным влиянием на прогноз. В исследовании НОРЕ показано снижение риска сердечно-сосудистых исходов и смертности при лечении пациентов высокого риска на фоне терапии рамиприлом на 22% (р < 0,001), а в подгруппе пациентов с диабетом - на 25%. В крупном ретроспективном когортном анализе рамиприл имел меньший риск смертности у пациентов с АГ и диабетом в сравнении с другими ингибиторами АПФ (каптоприлом, эналаприлом, фозиноприлом). В ряде исследований (ATLANTIS, MICRO-HOPE, DIABHYCAR) у пациентов с диабетом и МАУ рамиприл способствовал достоверному замедлению прогрессии МАУ и значимому регрессу МАУ, снижению риска развития диабетический нефропатии на 22%, что подтверждает выраженный нефропротективный эффект для первичной и вторичной профилактики нефропатии. В ряде исследований (AASK, НОРЕ, DREAM, ADaPT) при использовании рамиприла было показано снижение риска развития новых случаев сахарного диабета 2-го типа на 17-36%.

Таким образом, доказательные данные эффективности рамиприла позволили расширить показания к его применению не только для сердечно-сосудистых заболеваний (АГ, хроническая сердечная недостаточность, ИМ), но и для сахарного диабета и диабетической нефропатии, что значимо отличает препарат в ряду других ингибиторов АПФ.

AH and diabetes mellitus are comorbid diseases and are interconnected by general pathophysiological mechanisms of development, similar to cardiovascular complications. The presence of a close relationship between AH and diabetes mellitus is due to the importance of activation of the renin-angiotensin-aldosterone system, which underlies the remodeling of the cardiovascular sys­tem and the development of complications. According to modern clinical guidelines, ACE inhibitors are the drugs of choice in the treatment of AH in combination with diabetes mellitus. The use of ACE inhibitors in patients with AH and diabetes mellitus is accompanied by a reduction in the relative risk of cardiovascular outcomes and mortality. A scientific review of major clinical stud­ies with the results of efficacy of ACE inhibitor ramipril in patients with AH and diabetes mellitus is presented. Ramipril has a high affinity for ACE-1 and kinase II enzymes, pronounced clinical and organoprotective effects, proven to influence the prognosis. The HOPE study showed a 22% reduction in cardiovascular outcomes and mortality in high-risk patients treated with Ramipril (p < 0.001), and a 25% reduction in a subgroup of patients with diabetes mellitus. In a large retrospective cohort analysis, ramipril had a lower risk of mortality in patients with AH and diabetes mellitus compared to other ACE inhibitors (captopril, enalapril, fosinopril). In a number of studies (ATLANTIS, MICRO-HOPE, DIABHYCAR) in patients with diabetes mellitus and MAU, ramipril contributed to a significant slowdown of MAU progression and a significant regression of MAU, reducing the risk of diabetic nephropathy by 22%. This confirms the pronounced nephroprotective effect for primary and secondary nephropathy prevention. Several studies (AASK, HOPE, DREAM, ADaPT) using ramipril have shown a 17-36% reduction in the risk of the development of new cases of type 2 diabetes mellitus.

Thus, the evidence on the efficacy of ramipril has allowed to expand indications for its use not only for cardiovascular diseases (AH, chronic heart failure, MI), but also for diabetes mellitus and diabetic nephropathy, which significantly differs the drug from other ACE inhibitors.

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