Статья
Влияние ингибиторов ангиотензинпревращающего фермента и блокаторов рецепторов ангиотензина II на уровень мочевой кислоты в крови у пациентов с артериальной гипертензией: систематический обзор
Цель. Обобщить данные о влиянии антигипертензивных препаратов – ингибиторов ангиотензинпревращающего фермента (иАПФ) и блокаторов рецепторов ангиотензина II (БРА) - на уровень мочевой кислоты (МК) у взрослых пациентов с артериальной гипертензией (АГ) с целью оптимизации фармакотерапии АГ в сочетании с бессимптомной гиперурикемией.Материал и методы. Поиск осуществлялся в PubMed, Кокрейновском центральном регистре контролируемых исследований (CENTRAL) в Кокрейновской библиотеке Cochrane Library, eLIBRARY, сервисе Google Scholar и в базе текущих исследований Национальных институтов здравоохранения США ClinicalTrials.gov. Систематический обзор представлен в соответствии с рекомендациями PRISMA. При поиске и анализе статей не устанавливались ограничения по году публикации. Результаты. Анализ 9 рандомизированных контролируемых исследований иАПФ показал, что эналаприл, каптоприл и фозиноприл продемонстрировали нейтральность в отношении уровня МК, в то время как другие препараты этого класса могут повышать ее уровень. Анализ 11 рандомизированных контролируемых исследований БРА показал, что только лозартан обладает урикозурическим эффектом, тогда как ирбесартан, валсартан и эпросартан метаболически нейтральны.Заключение. Среди иАПФ хорошим профилем безопасности и наибольшей нейтральностью в отношении МК обладают эналаприл, рамиприл в малых дозах, фозиноприл. БРА в целом метаболически нейтральны в отношении МК, за исключением лозартана, обладающего урикозурическим эффектом.
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