nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2013-2402nnp-181Research ArticleArticlesСтатьиBlood pressure lowering-based prevention and the POWER trialПрофилактика инсульта на основе снижения артериального давления и исследование POWERParfenovVladimir AnatolyevichParfenovVladimir Anatolyevich

Department of Nervous System Diseases

Department of Nervous System Diseases

vladimirparfenov@mail.ruVerbitskayaS VVerbitskayaS V

Department of Nervous System Diseases

Department of Nervous System Diseases

-20131503201351NO1 (2013)6468Copyright © Parfenov V.A., Verbitskaya S.V., 20132013Parfenov V.A., Verbitskaya S.V.Parfenov V.A., Verbitskaya S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/181

Arterial hypertension is regarded as an independent and most important risk factor for stroke and its most effective prevention is to lower elevated blood pressure (BP). International guidelines on and the results of large randomized placebo-controlled trials of different antihypertensive drugs used to prevent stroke are given. How to optimize the outpatient prevention of stroke is discussed. The preliminary results of the POWER trial evaluating the safety and efficacy of eprosartan, an angiotensin receptor blocker, in reducing BP are presented.

Артериальная гипертензия рассматривается как независимый и важнейший фактор риска развития инсульта, а снижение повышенного артериального давления (АД) — как наиболее эффективная профилактика инсульта. Приведены международные рекомендации и результаты крупных рандомизированных плацебоконтролируемых исследований по использованию различных антигипертензивных средств для профилактики инсульта. Обсуждается оптимизация профилактики инсульта в амбулаторной практике. Представлены предварительные результаты исследования POWER, посвященного оценке безопасности и эффективности снижения АД на основе применения эпросартана, блокатора рецепторов к ангиотензину.

профилактика инсультаартериальная гипертензияантигипертензивные средстваэпросартанисследование POWERstroke preventionarterial hypertensionantihypertensive agentseprosartanPOWER trialReferences<div><p>Шевченко О.П., Праскурничий E.A., Яхно Н.Н., Парфенов В.А. Артериальная гипертония и церебральный инсульт. М., 2001; 192 с.</p><p>Суслина З.А., Гераскина Л.А., Фонякин А.В. Артериальная гипертония, сосудистая патология мозга и антигипертензивное лечение. М.: Медиаграфикс, 2006; 200 с.</p><p>Скворцова В.И., Губский Л.В., Стаховская Л.В. и др. Ишемический инсульт. В кн.: Неврология, национальное руководство. Под ред. Е.И. Гусева, А.И. Коновалова, В.И. Скворцовой. М.: ГЭОТАР-Медиа, 2009;592-615.</p><p>Парфенов В.А., Хасанова Д.Р. Ишемический инсульт. М.: МИА, 2012; 288 с.</p><p>Sacco R.L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457-507.</p><p>Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011;42:227-76.</p><p>Rosamond W.F., Furie K., Go A. et al. Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:є125—є146.</p><p>Vasan R.S, Larson M.G., Leip E.P et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001;345:1291-7.</p><p>Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 1995;346:1647-53.</p><p>Lewington S., Clarke R., Qizilbash N. еt al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.</p><p>Chalmers J., MacMahon S., Anderson C. et al. Clinician's manual on blood pressure and stroke prevention. 2nd ed. London, 2000; 129 p.</p><p>Neal B., MacMahon S., Chapman N. Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000;356:1955-64.</p><p>Verdecchia P., Staessen J.A., Angeli F. et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet 2009;374:525-33.</p><p>Lawes C.M.M., Bennett D.A., Feigin V.L., Rodgers A. Blood pressure and stroke: an overview of published reviews. Stroke 2004;35:776-85.</p><p>Rashid P., Leonardi-Bee J., Bath P.P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events. Stroke 2003;34:2741-8.</p><p>Zhang H.; Thijs L., Staessen J.A. Blood Pressure Lowering for Primary and Secondary Prevention of Stroke. Hypertension 2006;48:187-95.</p><p>Lakhan S.E, Sapko M.T. Blood pressure lowering treatment for preventing stroke recurrence: a systematic review and meta-analysis. Int Arch Med 2009;2:30.</p><p>Rothwell P.M., Howard S.C., Spence J.D. For the Carotide Endarterectomy Trialist's Collaboration. Relationship between Blood Pressure and Stroke Risk in Patients With Symptomatic Carotid Occlusive Disease. Stroke 2003;34:2583-92.</p><p>PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient schaemic attack. Lancet 2001;358:1033-41.</p><p>Schrader J., Luders S., Kulschewski A. et al. Mortality and morbidity after stroke, Eprosartan compared with Nitrendipine for secondary prevention. Principal results of a prospective randomised controlled study (MOSES). Stroke 2005;36:1218-26.</p><p>Schrader J., Kulschewski A., Dendorfer A. Inhibition of the renin-angiotensin system and the prevention of stroke. Am J Cardiovasc Drugs 2007;7:25-37.</p><p>Chobanian A.V., Bakris G.L., Black H.R. et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-72.</p><p>Парфенов В.А., Рыжак А.А. Неврологические аспекты оптимизации антигипер-тензивной терапиии. Неврол журн 2003;2:26-9.</p><p>Вербицкая С.В., Парфенов В.А. Вторичная профилактика инсульта в амбулаторных условиях. Неврол журн 2011;1:17-21.</p><p>De Backer G., Petrella J.R., Goudev A.R. et al. Design and methodology of POWER, an open-label observation of the effect of primary care interventions on total cardiovascular risk in patients with hypertension. Fundam Clin Pharmacol 2011; nov 4 [Epub ahead of print].</p><p>Plosker G.L. Eprosartan: a review of its use in hypertension. Drugs 2009;69:2477-99.</p><p>Goudev A., Berrou J.-P, Pathak A. Effect of eprosartan-based therapy on systolic blood pressure and total cardiovascular risk in a large international population: preliminary report of the observational POWER study. Vascular Health and Risk Management 2012;8:563-8.</p><p>Xu F.Y., Yang B., Shi D. et al. Antihypertensive effects and safety of eprosartan: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2012;68:195-205.</p><p>Flack J.M., Nasser S.A. Benefits of once-daily therapies in the treatment of hypertension. Vasc Health Risk Manag 2011;7:777-87.</p></div><br /><div><p>Шевченко О.П., Праскурничий E.A., Яхно Н.Н., Парфенов В.А. Артериальная гипертония и церебральный инсульт. М., 2001; 192 с.</p><p>Суслина З.А., Гераскина Л.А., Фонякин А.В. Артериальная гипертония, сосудистая патология мозга и антигипертензивное лечение. М.: Медиаграфикс, 2006; 200 с.</p><p>Скворцова В.И., Губский Л.В., Стаховская Л.В. и др. Ишемический инсульт. В кн.: Неврология, национальное руководство. Под ред. Е.И. Гусева, А.И. Коновалова, В.И. Скворцовой. М.: ГЭОТАР-Медиа, 2009;592-615.</p><p>Парфенов В.А., Хасанова Д.Р. Ишемический инсульт. М.: МИА, 2012; 288 с.</p><p>Sacco R.L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457-507.</p><p>Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011;42:227-76.</p><p>Rosamond W.F., Furie K., Go A. et al. Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:є125—є146.</p><p>Vasan R.S, Larson M.G., Leip E.P et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001;345:1291-7.</p><p>Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 1995;346:1647-53.</p><p>Lewington S., Clarke R., Qizilbash N. еt al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.</p><p>Chalmers J., MacMahon S., Anderson C. et al. Clinician's manual on blood pressure and stroke prevention. 2nd ed. London, 2000; 129 p.</p><p>Neal B., MacMahon S., Chapman N. Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000;356:1955-64.</p><p>Verdecchia P., Staessen J.A., Angeli F. et al. Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet 2009;374:525-33.</p><p>Lawes C.M.M., Bennett D.A., Feigin V.L., Rodgers A. Blood pressure and stroke: an overview of published reviews. Stroke 2004;35:776-85.</p><p>Rashid P., Leonardi-Bee J., Bath P.P. Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events. Stroke 2003;34:2741-8.</p><p>Zhang H.; Thijs L., Staessen J.A. Blood Pressure Lowering for Primary and Secondary Prevention of Stroke. Hypertension 2006;48:187-95.</p><p>Lakhan S.E, Sapko M.T. Blood pressure lowering treatment for preventing stroke recurrence: a systematic review and meta-analysis. Int Arch Med 2009;2:30.</p><p>Rothwell P.M., Howard S.C., Spence J.D. For the Carotide Endarterectomy Trialist's Collaboration. Relationship between Blood Pressure and Stroke Risk in Patients With Symptomatic Carotid Occlusive Disease. Stroke 2003;34:2583-92.</p><p>PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient schaemic attack. Lancet 2001;358:1033-41.</p><p>Schrader J., Luders S., Kulschewski A. et al. Mortality and morbidity after stroke, Eprosartan compared with Nitrendipine for secondary prevention. Principal results of a prospective randomised controlled study (MOSES). Stroke 2005;36:1218-26.</p><p>Schrader J., Kulschewski A., Dendorfer A. Inhibition of the renin-angiotensin system and the prevention of stroke. Am J Cardiovasc Drugs 2007;7:25-37.</p><p>Chobanian A.V., Bakris G.L., Black H.R. et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560-72.</p><p>Парфенов В.А., Рыжак А.А. Неврологические аспекты оптимизации антигипер-тензивной терапиии. Неврол журн 2003;2:26-9.</p><p>Вербицкая С.В., Парфенов В.А. Вторичная профилактика инсульта в амбулаторных условиях. Неврол журн 2011;1:17-21.</p><p>De Backer G., Petrella J.R., Goudev A.R. et al. Design and methodology of POWER, an open-label observation of the effect of primary care interventions on total cardiovascular risk in patients with hypertension. Fundam Clin Pharmacol 2011; nov 4 [Epub ahead of print].</p><p>Plosker G.L. Eprosartan: a review of its use in hypertension. Drugs 2009;69:2477-99.</p><p>Goudev A., Berrou J.-P, Pathak A. Effect of eprosartan-based therapy on systolic blood pressure and total cardiovascular risk in a large international population: preliminary report of the observational POWER study. Vascular Health and Risk Management 2012;8:563-8.</p><p>Xu F.Y., Yang B., Shi D. et al. Antihypertensive effects and safety of eprosartan: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2012;68:195-205.</p><p>Flack J.M., Nasser S.A. Benefits of once-daily therapies in the treatment of hypertension. Vasc Health Risk Manag 2011;7:777-87.</p></div><br />

The authors declare that there are no conflicts of interest present.