Роль бета-блокаторов в лечении сердечно-сосудистых заболеваний

Бета-адреноблокаторы используются для лечения различных сердечно-сосудистых заболеваний – от артериальной гипертензии до хронической сердечной недостаточности. Они действуют путем подавления действия катехоламинов через различные пути и влияют на частоту и силу сердечных сокращений, высвобождение ренина, обеспечивая антигипертензивный и антиишемический эффекты. Индивидуальное влияние различных препаратов этой группы на клинические исходы определяется характеристиками пациента, основным заболеванием, а также конкретным препаратом из группы бета-блокаторов. В последние годы бета-блокаторы столкнулись с серьезным препятствием, когда новые рекомендации по артериальной гипертензии предлагают их использовать в качестве второй линии терапии после ингибиторов ангиотензинпревращающего фермента, блокаторов рецепторов ангиотензина и блокаторов медленных кальциевых каналов при отсутствии четких показаний. В действительности же эти рекомендации были основаны на метаанализах, в которых было показано, что бета-блокаторы оказывают менее значимые эффекты в отношении общей смертности, сердечно-сосудистых событий и мозгового инсульта. Кроме того, согласно имеющимся на данный момент данным, назначение бета-блокаторов при таких заболеваниях, как сердечная недостаточность с сохраненной фракцией выброса и стабильная ишемическая болезнь сердца, может принести пациенту больше вреда, чем пользы. Бисопролол – бета-блокатор с самой высокой селективностью по отношению к бета1-адренорецепторам, что определяет редкую частоту побочных эффектов, развивающихся в результате его применения. В данном обзоре представлены актуальные данные по применению бета-адреноблокаторов в лечении сердечно-сосудистых заболеваний с акцентом на применение бисопролола.

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