Современные аспекты медикаментозной терапии синдрома хронической сердечной недостаточности

Т.В. Статкевич, Н.П. Митьковская

УО «Белорусский государственный медицинский университет», Республиканский научно-практический центр «Кардиология», Минск, Республика Беларусь

Хроническая сердечная недостаточность (ХСН) представляет собой важную не только медицинскую, но и социально-экономическую проблему для государства. Наличие синдрома ХСН не только значительно повышает риски неблагоприятного течения заболеваний, лежащих в его этиологической основе, но и само по себе через развитие декомпенсаций обуславливает высокую частоту смертельных исходов. Несмотря на все успехи фармакотерапии, прогноз у пациентов с сердечной недостаточностью остается неблагоприятным. Более 40% пациентов умирают в течение 4 лет после постановки диагноза сердечной недостаточности, а однолетняя смертность пациентов с тяжелой ХСН (класс IV по NYHA) превышает 50%. Вышеизложенное обуславливает необходимость и важность использования всех возможных медикаментозных и немедикаментозных технологий терапии, направленных на снижение смертности, увеличение продолжительности и качества жизни пациентов с ХСН, а также снижающих количество и вероятность декомпенсаций и связанных с ними госпитализаций, и делает это направление одним из самых приоритетных в медицине. В статье изложены современные подходы к лечению пациентов с синдромом ХСН с позиции доказательной медицины и с учетом рекомендаций ведущих международных организаций по лечению и профилактике сердечно-сосудистых заболеваний. Используемые лекарственные препараты проанализированы с позиции влияния на клиническую симптоматику, качество жизни пациентов, риск госпитализации в связи с декомпенсацией ХСН, а также показатели смертности. Сделан акцент на возможностях, механизме действия и дальнейших перспективах применения нового класса лекарственных препаратов в терапии ХСН, действующего на уровне ренин-ангиотензин-альдостероновой системы и системы нейтральных эндопептидаз – ингибитора рецепторов ангиотензина-неприлизина.

ключевые слова: хроническая сердечная недостаточность, медикаментозная терапия, ингибиторы рецепторов ангиотензина-неприлизина

для цитирования: Т.В. Статкевич, Н.П. Митьковская. Современные аспекты медикаментозной терапии синдрома хронической сердечной недостаточности. Неотложная кардиология и кардиооваскулярные риски, 2020, Т. 4, № 2, С. 1085–1096

Current aspects of drug therapy of chronic heart failure syndrome

T.V. Statkevich, N.P. Mitkovskaya

Chronic heart failure (CHF) is an important problem for the country, which has both medical and socio-economic aspects. The presence of the syndrome not only significantly increases the risks of an unfavorable course of diseases underlying its etiological basis, but in itself, through the development of decompensation, causes a high frequency of deaths. Despite all the advances in pharmacotherapy, the prognosis of heart failure remains poor. More than 40% of patients die within 4 years after the diagnosis of heart failure, and the one-year mortality rate for patients with severe CHF (NYHA class IV) exceeds 50%. The foregoing determines the need and importance of using all possible drug and non-drug therapy technologies aimed at reducing mortality, increasing the duration and quality of life of patients with CHF, as well as reducing the number and likelihood of decompensation and related hospitalizations, and makes this direction one of the priorities in medicine. The article describes current approaches to the treatment of patients with CHF syndrome from the perspective of evidence-based medicine and taking into account the recommendations of leading international organizations for the treatment and prevention of cardiovascular diseases. The drugs used were analyzed in terms of their influence on clinical symptoms, quality of life of patients, the risk of hospitalization due to decompensation of CHF, and mortality rates. The emphasis is made on the possibilities, mechanism of action and further prospects for the use of a new class of drugs in the treatment of CHF, acting at the level of the renin-angiotensin-aldosterone system and the system of neutral endopeptidases – inhibitors of angiotensin-neprilisin receptors.

keywords: chronic heart failure, drug therapy, angiotensin-neprilisin receptor inhibitors

for references: T.V. Statkevich, N.P. Mitkovskaya. Current aspects of drug therapy of chronic heart failure syndrome. Neotlozhnaya kardiologiya i kardioovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2020, vol. 4, no. 2, pp. 1085–1096

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