Статья
Фармакологические возможности в регрессии гипертрофии левого желудочка у пациентов с артериальной гипертензией
Гипертрофия левого желудочка (ГЛЖ), являющаяся основным проявлением гипертензивной болезни сердца, регистрируется у 15-45% пациентов с артериальной гипертензией (АГ), достигая 77% у больных с резистентной АГ, сопутствующим сахарным диабетом 2 типа и перенесенным сердечно-сосудистым событием. В представленном обзоре изложены основные вопросы определения, патофизиологии, эпидемиологии, диагностики и регрессии ГЛЖ на фоне антигипертензивной терапии. Приводятся рекомендации, критерии выявления, преимущества и недостатки электрокардиографии и эхокардиографии в ведении больных с АГ и ГЛЖ. Особое внимание в обзоре уделено обсуждению влияния ГЛЖ на сердечно-сосудистый прогноз и обоснованности регрессии гипертрофии. ГЛЖ нередко протекает с отсутствием или со стертыми клиническими проявлениями, однако со временем увеличивает риск развития сердечной недостаточности, фибрилляции предсердий, ишемической болезни сердца, внезапной сердечной смерти, инсульта и смерти от всех причин. Отмечается, что благодаря своевременному и адекватному применению антигипертензивной терапии удается не только снизить артериальное давление, но и добиться регрессии ГЛЖ, что благоприятно влияет на исход заболевания. Представлены основные группы лекарственной терапии, вызывающей регрессию ГЛЖ, среди которых подробно обсуждаются блокаторы ренин-ангиотензин-альдостероновой системы (ингибиторы ангиотензинпревращающего фермента, блокаторы рецепторов ангиотензина II, включая в комбинации с ингибитором неприлизина), β-адреноблокаторы, блокаторы кальциевых каналов, ингибиторы натрий-глюкозного котранспортера 2 типа и диуретики.
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