cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2017.10.10042cardio-40Research ArticleРАЗНОЕMISCELLANEOUSВыбор блокатора ангиотензиновых рецепторов на разных этапах сердечнососудистого континуумаChoice of Angiotensin Receptor Blocker at Various Stages of the Cardiovascular ContinuumПодзолковВ. И.PodzolkovV. I.noemail@neicon.ruДрагомирецкаяН. А.DragomiretskayaNatalia A.galanina_natalia@mail.ruФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова» Министерства здравоохранения Российской ФедерацииРоссияI. M. Sechenov First Moscow State Medical UniversityRussian Federation20171711201857104555Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/40

В статье представлены современные представления о компонентах, физиологических и патофизиологических эффектах ренин-ангиотензин-альдостероновой системы, путях ее гиперактивации на различных этапах сердечно-сосудистого и почечного континуума. Особое внимание уделено блокаторам рецепторов ангиотензина (сартанам). Приведены результаты многоцентровых рандомизированных клинических исследований, проведенных с препаратами данной группы. На основе их анализа определены клинические ситуации, позволяющие врачу сделать выбор в пользу того или иного препарата. Так, предпочтительным для пациентов с множественными факторами риска развития сердечно-сосудистых осложнений является назначение телмисартана, при нефропатии - ирбесартана, перенесшим острый инфаркт миокарда - валсартана, а при клинических признаках хронической сердечной недостаточности с низкой фракцией выброса - лозартана, валсартана и кандесартана.

We present in this paper modern views on components, physiological and pathophysiological effects of the renin-angiotensin system, pathways of its hyperactivation at various stages of the cardiovascular continuum. Special emphasis is made on angiotensin receptor blockers (sartans). Basing on results of analysis of randomized clinical trials of these agents we have outlined clinical situations in which prescription of one or another drug from this group is preferable. For patients with multiple risk factors of cardiovascular complications preferable agent is telmisartan, for patients with nephropathy - irbesartan, for survivors of acute myocardial infarction - valsartan, while for patients with clinical signs of chronic heart failure with low ejection fraction 3 agents can be designated as preferrable - losartan, valsartan, and candesartan.

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