Антагонисты минералокортикоидных рецепторов в практике врача-терапевта

Минералокортикоидные рецепторы играют существенную роль в патогенезе ряда заболеваний внутренних органов, включая сердечную недостаточность, артериальную гипертензию и хроническую болезнь почек. Их чрезмерная активация способствует развитию воспаления, фиброза, ремоделированию тканей и формированию кардио-рено-метаболического синдрома. Эффективность блокады минералокортикоидных рецепторов в реализации механизмов кардиопротекции и нефропротекции подтверждена крупными экспериментальными и клиническими исследованиями. При этом между стероидными и нестероидными антагонистами минералокортикоидных рецепторов существуют значимые различия в фармакологических свойствах.

В статье представлены особенности антагонистов минералокортикоидных рецепторов, зарегистрированных в Российской Федерации, включая их клинические эффекты, профиль безопасности и показания к применению. Особое внимание уделено алгоритму выбора препарата с учетом индивидуальных характеристик пациента, соотношения потенциальной пользы и рисков. Материал основан на актуальных европейских и отечественных клинических рекомендациях и предназначен для практического применения врачами-терапевтами при ведении пациентов с заболеваниями сердечно-сосудистой системы и почек.

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