Роль вітаміну D у розвитку, перебігу та лікуванні артеріальної гіпертензії

Abstract

The literature review considers the new universal molecule empagliflozin, which managed to change the glucose‑centric approach in endocrinology to an organoprotective one. The results of the pivotal clinical trials conducted with empagliflozin (EMPA‑REG‑OUTCOME, EMPEROR‑REDUCED, EMPEROR‑PRESERVED and EMPULSE) strongly support the ability of empagliflozin to reduce rates of cardiovascular death or hospitalization for heart failure and to slow down the progression of chronic kidney disease. Among the confirmed and potentially favorable metabolic consequences of empagliflozin administration, the following should be emphasized: a selective antihyperglycemic effect only in conditions of hyperglycemia/glucosuria, which does not depend either on insulin production or sensitivity of peripheral tissues to insulin but is limited only by the glomerular filtration rate. This effect allows avoiding hypoglycemia even in patients without diabetes. The drug is one of the most durable among oral hypoglycemic agents and allows to maintain the achieved HbA1c values for 6 — 8 years, delaying the initiation of insulin therapy in patients with type 2 diabetes mellitus. Empagliflozin was superior to placebo in preventing death from cardiovascular disease, nonfatal myocardial infarction, or nonfatal stroke in patients with type 2 diabetes mellitus. This effect resulted from the significant reduction in the risk of cardiovascular mortality without significant changes in nonfatal myocardial infarction or nonfatal stroke. Combination with other oral and injectable hypoglycemic drugs is possible. In case of combination with sulfonylurea drugs or insulin, the dose of the latter needs to be adjusted in the direction of its decrease. Weight loss of up to 2 — 3 kg against the background of empagliflozin is an expected phenomenon that can modify blood pressure indicators and insulin resistance. Empagliflozin has the ability to reduce steatosis and improve liver fibrosis scores in patients with NAFLD without type 2 diabetes mellitus.