Трехкомпонентные комбинации антиангинальных препаратов в лечении больных пожилого и старческого возраста со стабильной стенокардией напряжения


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Аннотация

Резюме Цель исследования. Сравнение эффективности и безопасности антиангинальной терапии (ААТ) у пациентов со стабильной стенокардией напряжения пожилого и старческого возраста сочетаниями бисопролола, ивабрадина и триметазидина или ранолазина. Материалы и методы. В исследовании участвовали 107 больных в возрасте от 60 до 79 лет с ишемической болезнью сердца и стенокардией напряжения II/III функционального класса. При сохранении стенокардии и/или безболевой ишемии миокарда на фоне приема бисопролола (1,25—2,5 мг 1 раз в сутки) и ивабрадина (2,5—7,5 мг 2 раза в сутки) после рандомизации 54 больным дополнительно назначали триметазидин (35 мг 2 раза в сутки), 53 — ранолазин (500 мг 2 раза в сутки). Перед рандомизацией и через 6 мес применения трехкомпонентной ААТ проводили комплексное клинико-инструментальное исследование. Результаты. Оба способа лечения хорошо переносились больными, существенно улучшали результаты теста с физической нагрузкой на тредмиле. Триметазидин в большей степени уменьшал продолжительность безболевой депрессии сегмента ST по данным холтеровского мониторирования электрокардиограммы. Триметазидин и ранолазин сопоставимо улучшали показатели систолической и диастолической функции левого желудочка, структурного и функционального состояния крупных артерий, качества жизни больных. Заключение. Комбинации низкой дозы β-адреноблокатора с ивабрадином и триметазидином или ранолазином могут применяться для лечения рефрактерной стабильной стенокардии у пациентов пожилого и старческого возраста. Использование триметазидина предпочтительнее из-за большей эффективности в отношении безболевой ишемии миокарда и более низкой стоимости.

Об авторах

С Г Канорский

Кубанский государственный медицинский университет Минздрава России

Краснодар, Россия

Н В Смоленская

Кубанский государственный медицинский университет Минздрава России

Краснодар, Россия

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