Коррекция определенных патофизиологических звеньев сердечно-сосудисто-почечного метаболического синдрома (часть вторая): роль применения моксонидина

Статья посвящена обсуждению проблемы остаточного риска развития осложнений сердечно-сосудистых заболеваний при лечении артериальной гипертонии (АГ) у пациентов с сердечно-сосудисто-почечным метаболическим синдромом (ССПМС). Рассматриваются современные рекомендации по тактике лечения АГ у пациентов с метаболическими факторами риска и необходимость достижения более низких целевых уровней АД в таких случаях. Приводятся данные, свидетельствующие о том, что недостаточное подавление активности симпатического отдела вегетативной нервной системы часто становится причиной такого остаточного риска. Подчеркивается высокая распространенность гиперсимпатикотонии у пациентов с ССПМС и ее отрицательное влияние на различные органы и системы. Представлена информация о том, что применение стандартных антигипертензивных препаратов не приводит к достаточному снижению активности симпатической нервной системы у пациентов с АГ. Обсуждаются результаты исследований, подтверждающих роль повышения симпатической активности у большого числа пациентов с ССПМС. Рассматриваются новые данные о возможной небезопасности использования b-блокаторов при лечении АГ, что обусловливает поиск альтернативных путей воздействия на симпатическую нервную систему при лечении АГ у пациентов с ССПМС. В связи с этим приводятся данные о возможностях длительного применения моксонидина в качестве одного из компонентов антигипертензивной терапии в такой клинической ситуации. Приводятся данные об антигипертензивной эффективности приема моксонидина. Указывается на возможность влияния приема моксонидина на скорость пульсовой волны. Рассматриваются не только антигипертензивное действие моксонидина, но и его плейотропные эффекты, включая влияние на маркеры аутофагии.

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