medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-278medsovet-8460Research ArticleЦЕРЕБРОВАСКУЛЯРНЫЕ ЗАБОЛЕВАНИЯCEREBROVASCULAR DISEASESАртериальная гипертензия как глобальная неврологическая проблема и перспектива многофакторной церебропротекции: фокус на комбинированные препаратыArterial hypertension as a global neurological problem and the prospect of multifactorial cerebroprotection: Focus on combination drugshttps://orcid.org/0000-0002-8655-8501ПутилинаМ. В.PutilinaM. V.

Путилина Марина Викторовна, д.м.н., профессор, профессор кафедры клинической фармакологии им. Ю.Б. Белоусова Института клинической медицины

117997, Москва, ул. Островитянова, д. 1

Marina V. Putilina, Dr. Sci. (Med.), Professor of the Department of Clinical Pharmacology named after Yu.B. Belousov, Institute of Clinical Medicine

1, Ostrovityanov St., Moscow, 117997

profput@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation20241408202401215–20Copyright © Путилина М.В., 20242024Путилина М.В.Putilina M.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8460

Согласно отчету Всемирной организации здравоохранения, в мире за относительно короткий период – около 10 лет – увеличилось количество пациентов с артериальной гипертензией: с 650 млн до 1,3 млрд. В неврологической практике колебания артериального давления ассоциированы с острыми нарушениями мозгового кровообращения, хронической ишемией головного мозга, когнитивными нарушениями, деменцией. В то же время низкое давление также вызывает необратимые изменения в коре головного мозга, особенно у пожилых пациентов, и сопряжено с риском развития сердечно-сосудистых заболеваний и нейродегенерации. Поэтому в зарубежной литературе колебания артериального давления рассматривают как глобальную неврологическую проблему. Многогранность патологических изменений при ряде факторов риска развития артериальной гипертензии требует раннего назначения церебропротекторов – препаратов, воздействующих на все звенья нейроваскулярной единицы. Одна из современных стратегий лечения – применение полипилюль, представляющих собой комбинацию двух или трех лекарственных веществ в одной таблетке. Стратегия полипилюль нашла отражение в новых схемах лечения неврологических заболеваний. Хорошо зарекомендовали себя комплексы нестероидных противовоспалительных препаратов с витаминами или миорелаксантами, нескольких антиоксидантов, двух нейропротекторов. Фиксированные комбинации – основа многофакторной церебропротекции без увеличения фармакологической нагрузки, способ повышения комплаенса. Фиксированная комбинация «Пикамилон + экстракт гинкго билоба» – пример оптимального синергизма как фармакодинамического (потенцирование и суммирование вазопротекторного и антиоксидантного эффекта Пикамилона, с одной стороны, усиление нейротрансмиттерного действия экстракта гинкго билоба – с другой), так и фармакокинетического (комплекс не требует корректировки доз, зависящих от возраста пациентов, так как состав подобран согласно длительным клиническим испытаниям в оптимальных дозировках) воздействия.

According to a WHO report, the number of patients with arterial hypertension in the world has increased from 650 million to 1.3 billion over a relatively short period of about 10 years. In neurological practice, fluctuations in blood pressure are associated with acute cerebrovascular accidents, chronic cerebral ischemia, cognitive impairment, and dementia. At the same time, low blood pressure also causes irreversible changes in the cerebral cortex, especially in elderly patients, and is associated with a risk of developing cardiovascular diseases and neurodegeneration, therefore, in foreign literature, fluctuations in blood pressure are considered a global neurological problem. The versatility of pathological changes in a number of risk factors for the development of hypertension requires early prescription of cerebroprotectors – drugs that affect all parts of the neurovascular unit. One of the modern treatment strategies is the use of polypills, which are a combination of 2 or 3 medicinal substances in one tablet. The polypill strategy is reflected in new treatment regimens for neurological diseases. Complexes of non-steroidal anti-inflammatory drugs with vitamins or muscle relaxants, several antioxidants, and two neuroprotectors have proven themselves to be effective. Fixed combinations are the basis for multifactorial cerebroprotection without increasing the pharmacological load, a way to increase compliance. The fixed combination of Picamilon + Ginkgo Biloba extract is an example of optimal synergism as pharmacodynamic (potentiation and summation of the vasoprotective and antioxidant effects of Picamilon on the one hand, enhancing the neurotransmitter effect of Ginkgo Biloba extract on the other) and pharmacokinetic (the complex does not require dose adjustment depending on the age of the patients, since the composition was selected according to long-term clinical trials in optimal dosages) action.

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