Клиническое значение гипертрофии левого желудочка и анализ влияния антигипертензивных препаратов на ее регресс

Авторы: Козиолова Н.А., Шатунова И.М.
Описание:

В обзорной статье представлены данные о распространенности гипертрофии левого желудочка (ГЛЖ) у больных артериальной гипертонией (АГ), предикторах развития, методах оценки, критериях диагностики ГЛЖ. Дан сравнительный анализ влияния антигипертензивных препаратов и их комбинаций на регресс ГЛЖ. Показана ведущая роль комбинированного лечения блокаторами ренин-ангиотензин-альдостероновой системы и антагонистами кальция дигидропиридинового ряда в снижении массы миокарда левого желудочка. Показаны преимущества фиксированных комбинаций в лечении больных АГ, в том числе при наличии ГЛЖ. Продемонстрированы преимущества низкого риска развития побочных эффектов и высокой приверженности к лечению при использовании антагонистов рецепторов к ангиотензину II в сравнении с другими классами антигипертензивных препаратов при выборе стартовой терапии больных АГ. Указаны неблагоприятные факторы, влияющие на скорость регресса ГЛЖ у больных АГ на фоне антигипертензивной терапии.


Прогностическое значение гипертрофии левого желудочка у больных артериальной гипертонией

У больных гипертонической болезнью (ГБ) ГЛЖ является ранним маркером поражения сердца, значительно увеличивает риск сердечно-сосудистых осложнений [1,2], общей смертности [3], внезапной кардиальной смерти [4-6]. На каждое увеличение массы миокарда левого желудочка (ММЛЖ), равное 50 г/м, индексированной на рост, частота сердечно-сосудистых осложнений и смерти увеличивается в 1,5 раза [1].

ГЛЖ является независимым предиктором развития острых цереброваскулярных событий у больных АГ. Так, по данным P.Verdecchia  и соавт., риск развития инсульта и транзиторной ишемической атаки (ТИА) при наличии электрокардиографических критериев ГЛЖ увеличивается на 79%, а при наличии эхокардиографических критериев – на 64%, независимо от возраста, пола, уровня АД, коморбидной патологии. На каждое, увеличение  индекса ММЛЖ (ИММЛЖ), равное 27 г/м2 , риск развития цереброваскулярных событий увеличивался на 31% [7].



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