medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-307medsovet-8606Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯARTERIAL HYPERTENSIONФенотип пациента с артериальной гипертензией для терапии кандесартаном и его комбинациями с диуретиком или антагонистом кальцияPhenotype of a patient with arterial hypertension for therapy with candesartan and its combinations with a diuretic or calcium antagonisthttps://orcid.org/0000-0001-5981-1754НедогодаС. В.SergeyS. V.

Недогода Сергей Владимирович, д.м.н., профессор, заведующий кафедрой внутренних болезней Института непрерывного медицинского и фармацевтического образования

400066, Волгоград, Площадь Павших Борцов, д. 1

Sergey V. Nedogoda, Dr. Sci. (Med.), Professor, Head of the Department of Internal Diseases, Institute of Continuing Medical and Pharmaceutical Education

1, Pavshikh Bortsov Square, Volgograd, 400131

nedogodasv@mail.ruhttps://orcid.org/0000-0001-6654-1000БолотоваС. Л.BolotovaS. L.

Болотова Светлана Леонидовна, к.м.н., доцент кафедры внутренних болезней Института непрерывного медицинского и фармацевтического образования

400066, Волгоград, Площадь Павших Борцов, д. 1

Svetlana L. Bolotova, Cand. Sci. (Med.), Associate Professor of the Department of Internal Medicine, Institute of Continuing Medical and Pharmaceutical Education

1, Pavshikh Bortsov Square, Volgograd, 400131

bolotovasl@yandex.ruhttps://orcid.org/0000-0002-7075-1235БычковаО. И.BychkovaO. I.

Бычкова Ольга Игоревна, к.м.н., подполковник медицинской службы, начальник, Военно-медицинская служба Управления Федеральной службы безопасности Российской Федерации по Волгоградской области; ассистент кафедры внутренних болезней Института непрерывного медицинского и фармацевтического образования, Волгоградский государственный медицинский университет

400066, Волгоград, Площадь Павших Борцов, д. 1,

400131, Волгоград, ул. Рокоссовского, д. 26

Olga I. Bychkova, Cand. Sci. (Med.), Lieutenant Colonel of the Medical Service, Head, Military Medical Service of the Federal Security Service Administration of the Russian Federation for the Volgograd Region; Assistant of the Department of Internal Medicine, Institute of Continuing Medical and Pharmaceutical Education, Volgograd State Medical University

1, Pavshikh Bortsov Square, Volgograd, 400131,

26, Rokossovsky St., Volgograd, 400131

bychkova_006@mail.ruhttps://orcid.org/0000-0001-6321-7205ВласовД. С.VlasovD. S.

Власов Даниил Сергеевич, аспирант кафедры внутренних болезней Института непрерывного медицинского и фармацевтического образования

400066, Волгоград, Площадь Павших Борцов, д. 1

Daniil S. Vlasov, Postgraduate Student of the Department of Internal Medicine, Institute of Continuing Medical and Pharmaceutical Education

1, Pavshikh Bortsov Square, Volgograd, 400131

danilvlasov@mail.ruhttps://orcid.org/0000-0003-4771-6025ЛедяеваА. А.LedyaevaA. A.

Ледяева Алла Александровна, к.м.н., доцент кафедры внутренних болезней Института непрерывного медицинского и фармацевтического образования

400066, Волгоград, Площадь Павших Борцов, д. 1

Alla A. Ledyaeva, Cand. Sci. (Med.), Associate Professor of the Department of Internal Medicine, Institute of Continuing Medical and Pharmaceutical Education

1, Pavshikh Bortsov Square, Volgograd, 400131

ledy-alla@yandex.ruhttps://orcid.org/0000-0002-6611-9165СаласюкА. С.SalasyukA. S.

Саласюк Алла Сергеевна, д.м.н., профессор кафедры внутренних болезней Института непрерывного медицинского и фармацевтического образования

400066, Волгоград, Площадь Павших Борцов, д. 1

Alla S. Salasyuk, Dr. Sci. (Med.), Professor of the Department of Internal Medicine, Institute of Continuing Medical and Pharmaceutical Education

1, Pavshikh Bortsov Square, Volgograd, 400131

salasyukas@outlook.comhttps://orcid.org/0000-0002-0662-1217ЦомаВ. В.TsomaV. V.

Цома Вера Владимировна, к.м.н., доцент кафедры внутренних болезней Института непрерывного медицинского и фармацевтического образования

400066, Волгоград, Площадь Павших Борцов, д. 1

Vera V. Tsoma, Cand. Sci. (Med.), Associate Professor of the Department of Internal Medicine, Institute of Continuing Medical and Pharmaceutical Education

1, Pavshikh Bortsov Square, Volgograd, 400131

vtsoma38@gmail.comВолгоградский государственный медицинский университетРоссияVolgograd State Medical UniversityRussian FederationВолгоградский государственный медицинский университет; Военно-медицинская служба Управления Федеральной службы безопасности Российской Федерации по Волгоградской областиРоссияVolgograd State Medical University; Military Medical Service of the Federal Security Service Administration of the Russian Federation for the Volgograd RegionRussian Federation2024291020240161118Copyright © Недогода С.В., Болотова С.Л., Бычкова О.И., Власов Д.С., Ледяева А.А., Саласюк А.С., Цома В.В., 20242024Недогода С.В., Болотова С.Л., Бычкова О.И., Власов Д.С., Ледяева А.А., Саласюк А.С., Цома В.В.Sergey S.V., Bolotova S.L., Bychkova O.I., Vlasov D.S., Ledyaeva A.A., Salasyuk A.S., Tsoma V.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/8606

Проведен обзор эффективности и безопасности применения кандесартана при артериальной гипертензии с позиции современных клинических рекомендаций, а также рассмотрены обновленные данные по эффективности и метаболическим эффектам различных комбинаций на его основе. Сформирован понятный фенотип пациента с артериальной гипертензией для выбора кандесартана, сформулированы принципы дифференцированного подхода к назначению комбинаций на его основе при лечении артериальной гипертензии с учетом метаболических эффектов и влияния на конечные точки. Показано, что кандесартан эффективнее ирбесартана, валсартана и лозартана способен снижать артериальное давление, может уменьшать риск развития артериальной гипертензии у лиц с нормальным высоким уровнем артериального давления или у молодых лиц с семейным риском, имеет самую большую и разноплановую доказательную базу при лечении хронической сердечной недостаточности, способен достоверно снижать риск развития сердечно-сосудистых осложнений, задерживать прогрессирование диабетической ретинопатии. Фенотип пациента для комбинации кандесартана с амлодипином предполагает наличие у пациента одного или нескольких из следующих состояний: метаболический синдром (особенно с нарушенной толерантностью к глюкозе и гипертриглицеридемией), необходимость целенаправленной ангиопротекции, гиперурикемия, склонность к гипокалиемии или необходимость замены других блокаторов рецепторов ангиотензина II на кандесартан в комбинации. Комбинация кандесартана с гидрохлоротиазидом предпочтительна для HOPE-3-подобных пациентов, пациентов с инсультом или транзиторной ишемической атакой в анамнезе, а также с повторными инсультами, наличием гиперволемии (ожирение, перименопауза), необходимостью в лечении или профилактике хронической сердечной недостаточности, замены других блокаторов рецепторов ангиотензина II на кандесартан в комбинации. При использовании комбинации с гидрохлоротиазидом с помощью суточного мониторирования артериального давления у пациента необходимо исключить вариант суточного профиля night-picker или non-dipper и утренний подъем артериального давления, поскольку длительность действия гидрохлоротиазида не превышает 12 ч. Для обеих комбинаций также доказано улучшение когнитивных функций.

The article provides a review on the efficacy and safety of the use of candesartan in hypertension through the lens of current clinical guidelines, and considers updated data on the efficacy and metabolic effects of different candesartan-based combinations. A clear phenotype of a patient with hypertension who can be selected for the prescription of candesartan has been built-up, and the principles of differentiated approach to prescribing candesartan-based combinations for the treatment of hypertension have been outlined, taking into account metabolic effects and impact on the end points. It has been shown  that candesartan is more effective than irbesartan, valsartan and losartan in lowering blood pressure, can reduce the risk of hypertension in people with normal high blood pressure or in young people with familial risks, and has the largest and most diverse evidence in the treatment of chronic heart failure, and significantly reduces the risk of cardiovascular complications as well as restrains the progression rates of diabetic retinopathy. The patient’s phenotype for the candesartan and amlodipine combination suggests that the presence of one or more of the following conditions: metabolic syndrome (particularly with impaired glucose tolerance and hypertriglyceridemia), the need for targeted angioprotection, hyperuricemia, hypokalemia tendency, or the necessity to replace other angiotensin II receptor blockers with candesartan-based combinations. The candesartan and hydrochlorothiazide combination is preferable for HOPE-3-like patients, patients with a history of strokes or transient ischemic attacks, as well as recurrent strokes, the presence of hypervolemia (obesity, perimenopause), the need for treatment or prevention of chronic heart failure, replacement of other angiotensin II receptor blockers with candesartan-based combinations. The prescription of the candesartan and hydrochlorothiazide combination using the 24-hour blood pressure monitoring in a patient requires to exclude the 24-hour night-picker or non-dipper profile and the morning blood pressure surge, as the effect of hydrochlorothiazide does not exceed 12 hours. Both combinations have also been shown to improve cognitive function.

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