Consilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum93933Research ArticleMesto antagonistov mineralokortikoidnykh retseptorov v terapii bol'nykh s KhSNOsmolovskayaYu. F-TereshchenkoS. N-ZhirovI. V-151020131510707428122021Copyright © 2013, Consilium Medicum2013хроническая сердечная недостаточностьальдостеронантагонисты минералокортикоидных рецепторов[ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33: 1787–847.][Mc Machon E. Recent studies with eplerenone, a novel selective aldosterone receptor antagonist. Curr Opin Pharmacol 2001; 1: 190–6.][Weber K.T, Villarreal D. Aldosterone, and antialdosterone therapy in congestive heart failure. Am J Cardiol 1993; 71 (Suppl. A): 3A–11A.][Yasky J, Ledesma G.A, Tutera A, Collia L.F. A fixed - dose combination of furosemide and spironolactone in digitalized congestive heart failure patients. Pharmatherapeutica 1986; 4 (8): 480–5.][Smith A.G. Spironolactone in the long - term management of patients with congestive heart failure. Curr Med Res Opin 1980; 7 (2): 131–6.][Muller J. Spironolactone in the management of congestive heart failure: a rewiew. Clin Ther 1986; 9 (1): 63–76.][Arriza J.L, Weinberger C, Cerelli G et al. Cloning of human mineralocorticoid receptor complementory DNA: structural and functional kinship with the glucocorticoid receptor. Sci 1987; 237 (4812): 268–75.][Корочкин И.М., Матвеева И.В. Гормональные нарушения и лечение больных с рефрактерными формами застойной сердечной недостаточности. Кардиология. 1977; 17 (8): 36–43.][Pierpont G.L, Francis G.S, Cohn J.N. Effect of captopril on renal function in patients with congestive heart failure. Br Heart J 1981; 46 (5): 522–7.][Sharpe D.N, Coxon R.J. Clinical and haemodynamic effects of low dose captopril in severe chronic heart failure. Br J Clin Phatmacol 1982; 14 (Suppl. 2): 161S–167S.][Nicholls M.G, Espiner E.A, Ikram H et al. Angiotensin II is more potent than potassium in regulating aldosterone in cardiac failure: evidence during captopril therapy. J Clin Endocrinol Metab 1981; 52 (6): 1253–6.][Swedberg K, Eneroth P, Kjekshus J, Wilhelmsen L. Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. CONSENSUS Trial Study Group. Circulation 1990; 82 (5): 1730–6.][The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987;316 (23): 1429–35.][Staessen J, Lijnen P, Fagard R et al. Rise in plasma concentration of aldosterone during long - term angiotensin II suppression. J Endocrinol 1981; 91 (3): 457–65.][Borghi C, Boschi S, Ambrosioni E et al. Evidence of a partial escape of reninangiotensine - aldosterone blocade in patients with acute myocardial infarctiontreated with ACE inhibitors. J Clin Pharmacol 1993; 33 (1): 40–5.][Lee A.F, Mac Fadyen R.J, Struthers A.D. Neurohormonal reactivationin heart failure patients on chronic ACE inhibitor therapy: a longitudinal study. Eur J Heart Fail 1999; 1 (4): 401–6.][Мареев В.Ю., Скворцов А.А., Челмакина С.М. и др. Способны ли ингибиторы АПФ эффективно контролировать активность ренин - ангиотензин - альдостероновой системы при длительном лечении хронической сердечной недостаточности? Кардиология. 1999; 39 (2): 27–34.][Urata H, Healy B.H, Stewart R et al. Angiotensin II forming pathways in normal and failing human hearts. Circ Res 1990; 66 (4): 883–90.][Muller J. Regulation of aldosterone biosynthesis: physiological and clinical aspects. Monogr Endocrinol, 2nd ed NY.: Springer-Verlag, 1988.][Mac Fadyen R.J, Lee A.F, Morton J.J et al. How often are angiotensin II and aldosterone concentrations raised during chronic ACE inhibitor treatment in cardiac failure? Heart 1999; 82 (1): 57–61.][Sato A, Saruta T. Aldosterone escape during angiotensin - converting enzyme inhibitor therapy in essential hypertensive patients with left ventricular hypertrophy. J Int Med Res 2001; 29 (1): 13–21.][Мареев В.Ю., Скворцов А.А. Блокада эффектов альдостерона у больных сердечной недостаточностью: современный взгляд на проблему – эплеренон (ч. II). Сердечная недостаточность. 2011; 12 (4) [66]: 222–7.][Pitt B, Zannand F, Remme W et al. The effect of spirinilactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999; 341: 709–17.][Delyani J, Myles K, Funder J et al. Eplerenone (SC 66110), a highly selective aldosteron antagonist. Am J Hypertens 1998; 11: 94A.][Degasparo M, Joss U, Ramjoue et al. Three new epoxy - spironolactone derivates: characterization in vivo and in vitro. J Pharmacol Exp Ther 1987; 240: 650–6.][Cook C.S, Berry L.M, Kim D.H et al. Involvement of CYP3A in the metabolism of eplerenone in humans and dogs: differential metabolism by CYP3A4 and CYP3A5. Drug Metab Dispos 2002; 30 (12): 1344–51.][Weinberger M.H, Roniker B, Krause S.L, Weiss R.J. Eplerenone, a selective aldosterone blocker, in mild - to - moderate hypertension. Am J Hypertens 2002; 15 (8): 709–16.][Sadee W, Dagcioglu M, Schroder R. Pharmacokinetics of spironolactone, canrenone and canrenoate-K in humans. J Pharmacol Exp Ther 1973; 185 (3): 686–95.][Pitt B, Roniker B. Eplerenone, a novel selective aldosteron receptor antagonist (SARA): dose – finding study in patients with heart failure. J Am Coll Cardiol 1999; 33: 188A–9A.][Zannad F, Mc Murray J.J.V, Drexler H et al. Rationale and design of the Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure (EMPHASIS-HF). Eur J Heart Fail 2010; 12 (6): 617–22.][Zannad F, Mc Murray J.J.V, Krum H et al. Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. N Engl J Med 2011; 364: 11–21.][Swedberg K, Zannad F, Mc Murray J.J et al. Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol 2012; 59 (18): 1598–603.][Pitt B, Remme W, Zannad F et al. Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction. N Engl J Med 2003; 348: 1309–21.][Mottram P.M, Haluska B, Leano R et al. Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure. Circulation 2004; 110 (5): 558–65.][Mak G.J, Ledwidge M.T, Watson C.J et al. Natural history of markers of collagen turnover in patients with early diastolic dysfunction and impact of eplerenone. J Am Coll Cardiol 2009; 54 (18): 1674–82.][Edwards N.C, Ferro C.J, Kirkwood H et al. Effect of spironolactone on left ventricular systolic and diastolic function in patients with early stage chronic kidney disease. Am J Cardiol 2010; 106 (10): 1505–11.][Deswal A, Richardson P, Bozkurt B, Mann D.L. Results of the Randomized Aldosterone Antagonism in Heart Failure with Preserved Ejection Fraction trial (RAAM-PEF). J Card Fail 2011; 17 (8): 634–42.][Edelmann F.W.R, Schmidt A.G et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: The Aldo-DHF randomized controlled trial. JAMA 2013; 309 (8): 781–91.][Desai A.S, Lewis E.F, Li R et al. Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: a randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction. Am Heart J 2011; 162 (6): 966–72, e910.][Guichard J, Donald Clark I.I, Calhoun D.A et al. Aldosterone receptor antagonists: current perspectives and therapies. Vasc Health Risk Manag 2013; 9: 321–31.]