Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya30933Editorial articleПередовая статьяLozartan potential in hyperuricemia correctionВозможности лозартана в коррекции гиперурикемииNedogodaSergey VladimirovichНедогодаСергей Владимирович

проф., проректор по лечебной работе ВолГМУ, зав. каф. терапии и эндокринологии ФУВ, гл. терапевт по Волгоградской области, тел.: 8(8442)97-42-51, 38-87-77; Волгоградский государственный медицинский университет

nedogodasv@rambler.ruNedogodaS V

State Medical University, Volgograd

Волгоградский государственный медицинский университетState Medical University, Volgograd151020118310NO10 (2011)ТОМ 83, №10 (2011)454810042020Copyright ©; 2011, Consilium MedicumCopyright ©; 2011, ООО "Консилиум Медикум"2011Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/30933

Recently, much attention of medical professionals is directed to correlations between hyperuricemia, arterial hypertension, metabolic syndrome and renal affection because of the evidence that elevated blood level of uric acid raises the risk of cardiovascular complications not only in arterial hypertension and metabolic syndrome but also in diabetes mellitus type 2, coronary heart disease, congestive heart failure and renal dysfunction. Administration of uricosuric medication in hyperuricemia and goat has contraindications in some cases. A number of trials show a corrective action of lozartan. Other blockers of receptors to angiotensin II has no such effect.

Изучение проблемы взаимосвязи гиперурикемии с артериальной гипертонией, метаболическим синдромом и поражением почек в последние годы стало весьма актуальным. Получены данные о том, что повышение уровня мочевой кислоты в крови увеличивает риск развития сердечно-сосудистых осложнений не только при артериальной гипертонии и метаболическом синдроме, но и при сахарном диабете 2-го типа, ишемической болезни сердца, застойной сердечной недостаточности и снижении функции почек. Применение урикозурических препаратов при гиперурикемии и подагре возможно не во всех случаях. В ряде исследований показано корректирующее действие блокаторов рецепторов к ангиотензину II лозартана, которым не обладают другие препараты этого класса.

hyperuricemialozartanhypertensionuric acidmetabolic syndromeгиперурикемиялозартангипертоническая болезньмочевая кислотаметаболический синдромAlderman М. Н. Uric acid and cardiovascular risk. Curr. Opin. Pharmacol. 2002; 2: 126-130.Bairaktari E. T., Kakafika A. I., Pritsivelis N. et al. Hypouricemia in individuals admitted to an inpatient hospital-based facility. Am. J. Kidney Dis. 2003; 41: 1225-1232.Ford E. S., Cook S., Choi H. K. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation 2007; 115: 2526-2532.Мухин H. A., Балкаров И. М., Максимов H. A. Клинические проявления нарушения пуринового обмена в практике интерниста. Тер. арх. 1994; 1: 35-39.Puig J., Martinez M. Hyperuricemia, gout, and the metabolic syndrome. Curr. Opin. Rheumatol. 2008; 20(2): 187-191.Глезер М. Г., Бойко H. B., Абильдинова А. Ж., Соболев К. Э. Факторы риска у московской популяции больных с артериальной гипертонией. Рос. кардиол. журн. 2002; 6: 16- 23.Кобалава Ж. Д., Котовская Ю. В., Толкачева В. В., Мальто А. С. Мочевая кислота - ключевой компонент кардиоренометаболического континуума. Кардиоваск. тер. и профилакт. 2008; 4: 95-106.Quarantino C. P., Di Sciacio N., Rucci C. et al. The normal range of serum urate levels and of fractional urate excretion. Adv. Exp. Med. Biol. 1994; 370: 91-93.Bulpitt C. J. Serum uric acid in hypertensive patients. Br. Heart J. 1975; 37: 1210-1215.Бугаева Н. В., Балкаров И. М. Артериальная гипертония и нарушение пуринового обмена. Тер. арх. 1996; 68(1): 36- 39.Джанашия П. Х., Диденко В. А. Является ли гиперурикемия компонентом метаболического синдрома? Рос. кардиол. журн. 2001; 1: 15-19.Донсков А. С., Балкаров И. М., Дадина З. М. и др. Уратное поражение почек и метаболические сдвиги у пациентов с артериальной гипертонией. Тер. арх. 1999; 6: 53-56.Лебедева М. В., Стахова Т. Ю., Минакова Е. Г. и др. Функция эндотелия у больных с артериальной гипертензией и нарушением обмена мочевой кислоты. Вестн. РАМН 2010; 12: 44-46.Sica D. A., Schoolwerth A. C. Part 1. Uric acid and losartan. Curr. Opin. Nephrol. Hypertens. 2002; 11: 475-482.France L. V., Pahor M., Di Bari M. et al. Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP). J. Hypertens. 2000; 18: 1149-1154.Mortality findings for stepped-care and referred-care participants in the hypertension detection and follow-up program, stratified by other risk factors. The Hypertension Detection and Follow-up Program Cooperative Research Group. Prev. Med. 1985; 14(3): 312-335.Verdecchia P., Schillaci G., Reboldi G. et al. Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PIUMA study. Hypertension 2000; 36: 1072-1078.Bengtsson C., Lapidus L., Stendahl C., Waldenstrom J. Hyperuricaemia and risk of cardiovascular disease and overall death. A 12-year follow-up of participants in the population study of women in Gothenburg. Sweden, Acta Med. Scand. 1988; 224: 549-555.Facchini F., Chen Y. D., Hollenbeck C. B., Reaven G. M. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. J. A. M. A. 1991; 266: 3008-3011.Johnson R. J., Kivlighn S. D., Kim Y.-G. et al. Reappraisal of the pathogenesis and consequences of hyperuricaemia in hypertension, cardiovascular disease, and renal disease. Am. J. Kidney Dis. 1999; 33: 225-234.Nakagawa T., Tuttle K., Short R. A., Johnson R. J. Hypothesis: fructose-induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome. Nat. Clin. Pract. Nephrol. 2005; 1: 80-86.Lehto S., Niskanen L., Ronnemaa T., Laakso M. Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke 1998; 29: 635-639.Urano W., Yamanaka H., Tsutani H. et al. The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J. Rheumatol. 2002; 29: 1950-1953.Löpez-Suärez A., Elvira-Gonzalez J., Bascuñana-Quirell A. et al. Serum urate levels and urinary uric acid excretion in subjects with metabolic syndrome. Med. Clin. (Barc.) 2006; 126: 321-324.Maesaka J. K., Fishbane S. Regulation of renal urate excretion: a critical review. Am. J. Kidney Dis. 1998; 32(6): 917-933.Tsouli S., Liberopoulos E. et al. Elevated serum uric acid levels in metabolic syndrome: an active component or an innocent bystander? Metabolism 2006; 93(6): 1293-1301.Mazzali M., Kanellis J., Han L. et al. Hyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure-independent mechanism. Am. J. Physiol. Renal Physiol. 2002; 282: F991-F997.Messerli F. H., Frohlich E., Dreslinski G. R. et al. Serum uric acid in essential hypertension: An indicator of renal vascular involvement. Ann. Intern. Med. 1980; 93(6): 817-821.Ruilope L. M., Garcia-Puig J. Hyperuricemia and renal function. Curr. Hypertens. Rep. 2001; 3: 197-202.Foley R. J., Weiman E. J. Urate nephropathy. Review. Am. J. Med. Sci. 1984; 288(5): 208-211.Steele T. H. Hyperuricemic nephropathies. Nephron 1999; 81(Suppl. 1): 45-49.Tykarski A. Evaluation of renal handling of uric acid in essential hypertension: hyperuricemia related to decreased urate secretion. Nephron 1991; 59: 364-368.Dawson J., Quinn T., Walters M. Uric acid reduction: a new paradigm in the management of cardiovascular risk? Curr. Med. Chem. 2007; 14(17): 1879-1886.Reyes A. J. Cardiovascular drugs and serum uric acid. Cardiovasc. Drugs Ther. 2003; 17(5-6): 397-414.Hamada T., Hisatome I., Kinugasa Y. et al. Effect of the angiotensin II receptor antagonist losartan on uric acid and oxypurine metabolism in healthy subjects. Intern. Med. 2002; 41: 793-797.Shahinfar S., Simpson R., Carides A. et al. Safety of losartan in hypertensive patients with asymptomatic hyperuricemia. JASN 1997; 8: 322.Shahinfar S., Simpson R. L., Carides A. D. et al. Safety of losartan in hypertensive patients with thiazide-induced hyperuricemia. Kidney Int. 1999; 56: 1879-1885.Alderman M., Aiyer K. J. Uric acid: role in cardiovascular disease and effects of losartan. Curr. Med. Res. Opin. 2004; 20(3): 369-379.Masako F., Toshihiro H. Mechanism of angiotensin II receptor antagonist losartan on uric acid metabolism. Gout Nucleic Acid Metabolism 2000; 24: 31-37.Мухин Н. А., Балкаров И. М., Моисеев С. В. и др. Урикозурическое действие лозартана. Клин. фармакол. и тер. 2003; 12(5); 55-58.Daijiro U., Hiroaki K. Long-term effects of angiotensin II receptor antagonist losartan on uric acid metabolism in hyperuricemic patients. Gout Nucleic Acid Metabolism 2002; 26: 25- 32.Daskalopoulou S. S. et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int. 2004; 66(4): 1714-1715.Liberopoulos E., Christides D., Elisaf M. Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricemia and gout. J. Hypertens. 2002; 20: 347.Manolis A. J., Grossman E., Jelakovic B. et al. Effects of losartan and candesartan monotherapy and losartan/hydrochlorothiazide combination therapy in patients with mild to moderate hypertension. Losartan Trial Investigators. Clin. Ther. 2000; 22: 1186-1203.Puig J. G., Mateos F., Buno A. et al. Effect of eprosartan and losartan on uric acid metabolism in patients with essential hypertension. J. Hypertens. 1999; 17: 1033-1039.Würzner G. Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaemia and gout. J. Hypertens. 2002; 20(2): 347.Takahashi S., Moriwaki Y. Effects of combination treatment using anti-hyperuricaemic agents with fenofibrate and/or losartan on uric acid metabolism. Ann. Rheum. Dis. 2003; 62: 572-575.Owens P., Kelly L., Nallen R. et al. Comparison of antihypertensive and metabolic effects of losartan and losartan in combination with hydrochlorothiazide - a randomized controlled trial. J. Hypertens. 2000; 18: 339-345.Soffer B. A., Wright J. T., Jr, Pratt J. H. et al. Effects of losartan on a background of hydrochlorothiazide in patients with hypertension. Hypertension 1995; 26: 112-117.De Rosa M. L., Cardace P., Rossi M. et al. Comparative effects of chronic ACE inhibition and AT1 receptor blocked losartan on cardiac hypertrophy and renal function in hypertensive patients. J. Hum. Hypertens. 2002; 16(2): 133-140.Leonetti G. Comparison of metabolic and hemodynamic effects of hydrochlorothiazide in monotherapy and in association with lisinopril. An Italian multicenter study. Minerva Cardioangiol. 1995; 43(9): 389-398.Athyros V. G., Elisaf M., Papageorgiou A. A. Effect of statins versus untreated dyslipidemia on serum uric acid levels in patients with coronary heart disease: a subgroup analysis of the GREck Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study. Am. J. Kidney Dis. 2004; 43: 589-599.Milionis H., Kakafika A. Effects of statin treatment on uric acid homeostasis in patients with primary hyperlipidemia. Am. Heart J. 2004; 148(4): 635-640.