Статья
Возможности и ограничения применения бета-адреноблокаторов у больных сердечно-сосудистыми заболеваниями и хронической обструктивной болезнью легких
В медицинской литературе все больше внимания уделяется сопутствующим заболеваниям у больных хронической обструктивной болезнью легких (ХОБЛ). В клинической практике врачи нередко опасаются назначать бета-адреноблокаторы (бета1‑адреноблокаторы) пациентам с ХОБЛ. В настоящей статье обобщаются новые результаты использования бета-адреноблокаторов у пациентов с ХОБЛ. По данным литературы, терапия селективными бета1‑адреноблокаторами существенно увеличивает выживаемость пациентов с ХОБЛ в сочетании с ишемической болезнью сердца, особенно перенесенным инфарктом миокарда (ИМ), и хронической сердечной недостаточностью (ХСН). Польза от назначения селективных бета1‑адреноблокаторов при ХСН, ИМ в анамнезе перевешивает потенциальный риск, связанный с лечением, даже у пациентов с тяжелой ХОБЛ. Отсутствуют убедительные данные о пользе назначения бета1‑адреноблокаторов больным ХОБЛ без указанных сочетанных состояний. В настоящее время терапия селективными бета1‑адреноблокаторами считается безопасной у пациентов с сердечно-сосудистыми заболеваниями и ХОБЛ, поэтому такие кардиоселективные бета1-адреноблокаторы, как бисопролол, метопролол или небиволол, могут быть использованы в лечении пациентов из этой когорты. Неселективные бета-адреноблокаторы могут вызывать бронхоспазм и не рекомендуются к применению у пациентов с ХОБЛ. При использовании бета-адреноблокаторов с внутренней симпатомиметической активностью вероятность прогрессирования бронхообструкции у больных ХОБЛ меньше, но эту группу препаратов не сравнивали c кардиоселективными бета-адреноблокаторами. В целях безопасности прием бета1‑адреноблокаторов необходимо начинать вне периода обострения ХОБЛ с небольшой дозы. Рекомендуется тщательно мониторировать возможное появление новых симптомов в виде появления / нарастания одышки, кашля или изменения в приеме других препаратов (например, повышение частоты приема короткодействующих бронхолитиков).
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