Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum92869ArticlesСтатьиResearch ArticlePryamoe ingibirovanie renina – innovatsionnyy podkhod k blokade renin-angiotenzin-al'dosteronovoy sistemyПрямое ингибирование ренина – инновационный подход к блокаде ренин-ангиотензин-альдостероновой системыArutyunovG. PАрутюновГ. П

доктор мед. наук, проф.

ГОУ ВПО РГМУ Росздрава, Москва15052009115VOL 11, NO5 (2009)ТОМ 11, №5 (2009)152028122021Copyright ©; 2009, Consilium MedicumCopyright ©; 2009, ООО "Консилиум Медикум"2009Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/92869

Ренин-ангиотензин-альдостероновая система (РААС) играет ключевую роль в регуляции артериального давления (АД). Хроническая активация РААС приводит к развитию артериальной гипертензии (АГ) и в конечном итоге к поражению органов-мишеней (Mu..ller, Luft, 2006). Препараты, действующие на РААС, например ингибиторы ангиотензинпревращающего фермента (ИАПФ) и блокаторы рецепторов ангиотензина (БРА), являются эффективными методами терапии АГ и значительно снижают частоту сердечно-сосудистых и почечных осложнений (Weber, Giles, 2006). Однако угнетение образования ангиотензина II (АII) при применении ИАПФ или блокада его эффектов при применении БРА приводят к увеличению секреции ренина почками, следовательно ИАПФ и БРА стимулируют компенсаторное повышение активности ренина плазмы (АРП) и в результате ИАПФ и БРА обеспечивают только частичное подавление РААС (Mu..ller, Luft, 2006). В отличие от ИАПФ и БРА прямой ингибитор ренина – препарат Расилез (алискирен) – действует на ключевое звено активации РААС – фермент ренин, угнетая его активность. Ренин расщепляет ангиотензиноген и образует. Таким образом при применении прямого ингибитора ренина уменьшается уровень и АI, и АII, и АРП (Azizi и соавт., 2006). Можно предположить, что вследствие прямого ингибирования ренина Расилез сможет обеспечить более совершенный контроль РААС, чем ИАПФ или БРА, путем воздействия на ключевое звено активации системы.

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