Перспективы применения препарата валсартан+сакубитрил при гипертоническом сердце

Течение артериальной гипертонии часто осложняется развитием гипертрофии левого желудочка (или гипертонического сердца (ГС). Основным “коридором” естественного течения ГС является развитие сердечной недостаточности с сохранённой фракцией выброса (СНсФВ). При СНсФВ значительно снижается биодоступность натрийуретических пептидов (НУП), в результате чего ослабевает активность внутриклеточной сигнальной оси цГМФ-PKG, играющей ключевую роль в поддержании нормальной диастолической функции. Повысить активность этой оси можно с помощью ингибитора неприлизина сакубитрила. При СНсФВ наибольшей эффективности от препарата валсартан+сакубитрил (В+С) следует ожидать у пациентов с тяжёлой концентрической гипертрофией левого желудочка, имеющих максимально выраженный синдром “дефицита НУП”. Препарат В+С обладает чётким гипотензивным эффектом, вызывает реверсию гипертрофии и фиброза левого желудочка. Поскольку для СНсФВ до сих пор не найдено эффективных средств лечения, основным принципом лечения ГС должно являться предотвращение прогрессии диастолической дисфункции, что оправдывает применение В+С начиная с ранних/бессимптомных стадий ГС.

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