?? ?????? ???? ????????????, ??????? ?????????? ?????-???????????-??????????????? ??????? ? ??????? ??????????? ???????????????????????? ???????? (????) ? ?????????? ?????????? ???????????? II (???) ????? ???? ???????????? ???????? ? ??????? ? ?????????? ??????????? ?????? ????????? (??). ?????? ???????? ???????????? ?????????? ????? ????????? ????????????? ???????? ???????, ? ????????? ??????? ????????????? ? ???????? ???????????????, ????? ?????????????? ????????? ????? ???????. ??????? ? ??????? ????????????? ACC/AHA ?? ??????? ??????? ????????? ???????????????? (??) ??????
?????????? ????? ????? ???????????? IIb*. ?-? C.O.Phillips et al. ??????? ?????????????? ????? ?????? ????????????????? ??????????? ????????? (???) ??? ????????? ???????????? ???????? ???????? ?????????? ????+??? ? ????????? ? ????????? ? ??????? ? ?????????? ??????????? ??.
?????? ? ??? ????????????.
????? ?????????? ??? ???????? ? MEDLINE, EMBASE, ???????????? ??????????, ???????????? ????????? ??????????? ????????? ????????, ?????? ?????????? ?? ??????? ?? ????????? ??????? ????????? ? ???????? ???, ?????????????? ?? ??????? 2006 ?. ?????????? ?????? ??? ????: ????????????????? ??????, ????????? 500 ? ????? ?????????? ? ?????? ?????????? ????+??? ??? ???????? (??????????? ??????? ? ??????????? ????), ??????????? ?? ????? 3 ??????? ? ??????????? ????????? ?????????.
????????? ???????? ???????????? ???? ??????? ??????????? ?????? ?????????? ??-?? ???????? ??????? (??????????; ??????; ?????????????????? ????; ????????? ??????? ?????, ???????????? ??? ????????? ?????? ?????????? ????????? ????? > 0,5 ??/?? [44,2 ??????/?], ????????????? > 5,5 ?????/?; ?????????? ??????????). ???? ????????? ? ?????? ?????????? ???? ?????????? ??? ????????? ???, ??????????? ???????? ??????????, ????????????? ? ?????????? ???????????? ?????????? ? ?????????? ?????????? ???? ????????.
?????? ?? ??????? ?? ??????????? ???????, ???????? ??? ????????? ????????????? ???? (??) ? 95% ????????????? ???????? (??) ??? ??? ??????????? ??????????? ?????????????, ??? ? ??? ?????????? ???????? ???????? ??????? ????+??? ? ????????? ? ?????????.
??????????.
????? ???? ???????? 4 ??? (n=17 337), ??????????????? ??????????????? ?????????. ???????????? ???? ???????? 2 ????????? ?????????: ? ??????????? ?????????? ?? (n=7543; ??????? ??????? – 63 ????; 82% – ???????; ??????? ??????? ??????? [??] ?? – 27%; ??????? ???????????? ?????????? – 25 ???????) ? ?????? ????????? ???????? (???), ??????????? ??????????? ?? (n=9794; ??????? ??????? – 65 ???; 69% – ???????; ??????? ?? ?? – 35%; ??????? ????????????????? ?????????? – 24,7 ???????). ?????????? ?????????? (??????? ???? – 320 ??/???) ? ???? (? ????? ??? – ? ??????????? ? ??????? ???? 150 ??/???, ? ?????? – ? ?????????? ???????????) ??????????? ? 2 ?????????? (VALIANT; ValHeFT), ?????????? ???????????? (??????? ???? – ?? 8 ??) – ????? ? 2 ??? (CHARM-added; RESOLVED): ? ????? – ? ??????????? ? ???? 20 ??/???, ? ?????? – ? ?????????? ????.
?????????? ????+??? ?????????????? ??????????? ??????????? ??????? ??????????? ??????? ??-?? ???????? ??????? ??? ? ????????? ? ??????????? ?? (15% ?????? 11% ? ????????; ?? – 1,38; 95% ?? – 1,22–1,55; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 25), ??? ? ? ??????? ? ??? (9,0% ?????? 7,6% ? ????????; ?? – 1,17; 95% ?? – 1,03–1,34; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 71).
??????? ????+??? ????????? ? ????????? ????? ????? ?????????? ???????????? ?????????? ? ????????? ?? (2,4% ?????? 1,5% ? ????????; ?? – 1,50; 95% ?? – 1,09–2,07; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 111) ? ? ??????? ??? (18,1% ?????? 11,9%; ?? – 1,48; 95% ?? – 1,33–3,18; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 16).
????????? ??????? ????? ??? ?????????? ????+??? ?????????? ????? ??? ? 2 ???? ????, ??? ? ????????, ??? ? ??????? ? ?? (3,3% ?????? 1,5% ? ????????; ??– 2,17; 95% ?? – 1,59–2,97; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 56), ??? ? ? ????????? ? ??? (4,8% ?????? 3,0%; ?? – 1,61; 95% ?? – 1,31–1,98; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 56). ????????????? ? ??????? ???????, ????????????????? ?? ??????? ????+???, ??????????? ????? ??????????? ????, ??? ? ????????, ? ????????? ? ?? – 3,5% ?????? 0,7% ?????????????? (?? – 4,87; 95% ?? – 2,39–9,94; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 36), ?? ?? ? ??????? ? ??? – 1,2% ?????? 0,9% (?? – 1,33; 95% ?? – 0,90–1,98; ????? ??????????? ????????? ??? ???????? ?????? ????????? ??????? – 333).
??????.
?????????? ??????? ???????????????? ?????? ???????????? ???????????? ???????? ???????????? ???????????? ?????????? ?????????? ???? ? ??? ? ??????? ? ????????????? ?????????? ??????????? ??. ?????? ?????????? ?????????????? ?????????? ????? ??????, ??? ??? ??????????? ???????, ???????????? ?????? ?????????? ??-?? ???????? ????????, ??????? ???????? ?????????? ??????????, ????????? ??????? ????? ? ?????????????. ? ?????? ?????????? ??????, ?? ?????? 1000 ??????????? ????????? ??????????? ????+??? 25 ??????? ????????? ???????, ? 17 – ????????? ??????? ?????, ? 8 – ?????????? ????????????? ? ? 36 – ?????????? ??????????.
?????????? ?????????? ??????????? ? ???????? ?????????????? ?? ??????? ??????? ??, ????????? ??? ???????? ???????? ?????????? ????+??? ? ?????? ????????? ?????????.
????????.
Phillips C.O., Kashani A., Ko D.K. et al. Adverse Effects of Combination Angiotensin II
Receptor Blockers Plus Angiotensin-Converting Enzyme Inhibitors for Left Ventricular Dysfunction. A Quantitative Review of Data From Randomized Clinical Trials. Arch Intern Med. October 8, 2007;167(1
:1930-1936.??????-????????. Medline ????????.
http://www.medmir.com/content/view/1834/61/
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