Incidenţa reacţiilor adverse la preparatele antihipertensive la bărbaţi şi femei

Abstract

Introducere. Studiile farmacoepidemiologice au relatat o incidenţă de circa 1,5-1,7 ori mai mare a reacţiilor adverse la medicamente la femei decât la bărbaţi. La utilizarea preparatelor antihipertensive s-au constatat diferenţe de sex şi gen referitor la eficacitatea şi inofensivitatea tratamentului antihipertensiv. Scopul lucrării - elucidarea particularităţilor reacţiilor adverse la femei şi bărbaţi la prescrierea preparatelor antihipertensive. Material şi metode. S-a efectuat o selectare şi analiză a articolelor în baza de date PubMed din ultimii 10 ani referitor la reacţiile adverse la medicamentele antihipertensive la bărbaţi şi femei. Rezultate. La femei mai frecvent s-au raportat reacţii adverse, inclusiv: hiponatriemie, hipokaliemie şi aritmii (diureticele tiazidice]; hirsutism (antagoniştii aldosteronului); hipotensiune arterială, palpitaţii, edeme maleolare, hiperemia feţei, bufeuri, cefalee, ameţeli, oboseală (antagoniştii calciului, di- hidropiridine); bronhospasm, tuşea uscată, edem angioneurotic (inhibitorii enzimei de conversie a angiotensin ei). La bărbaţi s-a constatat o incidenţa mai mare a următoarelor reacţii adverse: hipovolemie, hiperuricemie, accese de gută, calculi oxalaţi şi nefrolitiază, disfuncţii sexuale (diureticele tiazidice); ginecomastie, tensionarea sânilor, galactoree (antagoniştii aldosteronului); dereglări sexuale şi disfuncţii erectile (beta-adrenoblocante). Concluzii. Incidenţa reacţiilor adverse la femei s-a raportat a fi determinate de: po- literapie; diferenţe ale farmacodinamiei, farmacocineticii şi farmacogeneticii medicamentelor; fonul hormonal; factorii imunologici; neadaptarea dozelor la masa corporală, absenţa ghidurilor pentru abordarea terapeutică a hipertensiunii arteriale la bărbaţi şi femei.

Introduction. Pharmacoepidemiological studies have reported an approximately 1.5-1.7-fold higher incidence of adverse drug reactions in women than in men. Sex and gender differences in the efficacy and safety of antihypertensive treatment have been observed in the use of antihypertensive preparations. The aim of the study - to elucidate the peculiarities of adverse reactions in women and men in the prescription of antihypertensive preparations. Material and methods. A selection and analysis of articles in the PubMed database from the last 10 years on adverse reactions to antihypertensive drugs in men and women was performed. Results. Adverse reactions were more commonly reported in women, including: hyponatremia, hypokalemia and arrhythmias (thiazide diuretics); hirsutism (aldosterone antagonists); hypotension, palpitations, malleolar edema, facial hyperemia, hot flushes, headache, dizziness, fatigue (calcium antagonists, dihydropyridines); broncho- spasm, dry cough, angioneurotic edema (angiotensin-converting enzyme inhibitors). In men there was a higher incidence of the following adverse reactions: hypovolemia, hiperuricemia, gout attacks, oxalate stones and nephrolithiasis, sexual dysfunction (thiazide diuretics); gynecomastia, breast tenderness, galactorrhea (aldosterone antagonists); sexual dysfunction and erectile dysfunction (beta-adreno- blockers). Conclusions. The incidence of adverse reactions in women has been reported to be determined by polypharmacy; differences in pharmacodynamics, pharmacokinetics and pharmacogenetics of drugs; hormonal and immunological factors; non-adjustment of doses to body mass, absence of guidelines for therapeutic approach to hypertension in men and women.