PROTUATEROSKLEROTSKI UČINCI ANTIHIPERTENZIVA

KREŠIMIR GALEŠIĆ

Arterijska hipertenzija jedan je od vodećih uzroka ateroskleroze te je zadnjih godina velik broj istraživanja antihipertenziva bio fokusiran na prevenciju, zaustavljanje i po mogućnosti regresiju ateroskleroze. Neki antihipertenzivi koje rabimo u svakodnevnoj praksi osim smanjenja sistemskoga krvnog tlaka imaju dodatni protuaterosklerotski učinak. U patogenezi ateroskleroze u bolesnika s arterijskom hipertenzijom sudjeluju oksidativni procesi i slobodni radikali kisika čija je koncentracija povišena u arterijskoj hipertenziji. Antioksidansi su tvari koje neutraliziraju slobodne radikale kisika. Osim endogenih antioksidansa (vitamin E, vitamin C i dr.) i neki antihipertenzivi imaju svojstva antioksidansa, tj. mogu smanjiti aktivnost slobodnih radikala kisika. To su blokatori kalcija, ponajprije dihidropiridinska skupina, ACE-inhibitori, β-blokator karvedilol i blokator a-receptora doksazosin. Protuaterosklerotski učinak antihipertenziva pokazan je u pokusima na životinjama, in vitro, ali danas postoje i kliničke studije. Rezultati najpoznatijih kliničkih studija protuaterosklerotskog učinka antihipertenziva bit će prikazani u daljnjem tekstu

Summary. Arterial hypertension is one of the leading causes of atherosclerosis. Many studies of antihypertensive drugs have been recently focused on prevention, stopping and if possible regression of atherosclerosis. Some antihypertensive drugs which are used in clinical practice have antiatherosclerotic effects besides their effects on the reduction of systemic blood pressure. Oxydative processes and oxygen free radicals participate in the pathogenesis of atherosclerosis. The concen- tration of oxygen free radicals is increased in patients with arterial hypertension. Antioxidant could neutralise oxygen free radicals. There are endogenous antioxidants like vitamin E, vitamin C etc. Some antihypertensive drugs have antioxidant properties and they could neutralise free oxygen radicals. These drugs are: calcium channel blockers, ACE-inhibitors, b-blocker carvedilol and blocker of a-receptors-doxazosine. Antiatherosclerotic effects of these drugs have been shown in experiments in vivo, in animals as well as in clinical studies. The results of the most important clinical studies will be presented in the following text.