Wyszuk. zaawans.

Tom 19, Nr 4 (2022)
Artykuł przeglądowy
Opublikowany online: 2023-03-31

dostęp otwarty

Pokaż PDF Pobierz plik PDF
Wyświetlenia strony 860
Wyświetlenia/pobrania artykułu 331
Pobierz cytowanie

Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Nadciśnienie tętnicze i jego leczenie a prewencja zaburzeń funkcji poznawczych — rola połączenia walsartanu i amlodipiny. Przegląd dla lekarza praktyka

Stanisław Surma1, Michał O. Zembala23
DOI: 10.5603/ChSiN.2022.0019
Choroby Serca i Naczyń 2022;19(4):160-177.

Streszczenie

Nadciśnienie tętnicze i demencja stanowią istotny problem współczesnej medycyny. Wśród wielu czynników ryzyka rozwoju zaburzeń funkcji poznawczych, szczególnie u osób w średnim wieku, znajduje się nadciśnienie tętnicze. Związek między nadciśnieniem tętniczym a zaburzeniami funkcji poznawczych jest złożony i nie ogranicza się jedynie do zwiększonego ciśnienia tętniczego, ale obejmuje także ciśnienie tętna, prędkość fali tętna, zmienność ciśnienia tętniczego oraz hipotonię ortostatyczną. Leki przeciwnadciśnieniowe są jedynymi znanymi lekami, które mogą zmniejszać ryzyko wystąpienia demencji. Szczególną rolę w prewencji zaburzeń funkcji poznawczych pełnią antagoniści wapnia (amlodipina) oraz sartany (walsartan). Leki te charakteryzują się korzystnym wpływem na wszystkie istotne w prewencji demencji czynniki związane z kontrolą ciśnienia tętniczego. Co więcej, są korzystne w prewencji udaru mózgu, który jest ważnym czynnikiem ryzyka demencji. Możliwość stosowania amlodipiny w połączeniu z walsartanem w postaci jednej tabletki dodatkowo zwiększa przestrzeganie zaleceń terapeutycznych, co przekłada się na lepszą kontrolę ciśnienia tętniczego i w konsekwencji na lepszą prewencję zaburzeń funkcji poznawczych. W niniejszym artykule podsumowano związek między nadciśnieniem tętniczym i jego leczeniem, ze szczególnym uwzględnieniem amlodipiny i walsartanu, a ryzykiem zaburzeń funkcji poznawczych.

Słowa kluczowe: nadciśnienie tętniczedemencjafunkcje poznawczewalsartanamlodipina

Artykuł dostępny w formacie PDF

Pokaż PDF Pobierz plik PDF

Referencje

  1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021; 398(10304): 957–980.
    CrossRefPubMed
  2. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022; 7(2): e105–e125.
    CrossRefPubMed
  3. Wolska-Bułach A, Wierzowiecka M, Niklas K, et al. Cognitive dysfunctions in patients with hypertension — pathogenesis and treatment. Arterial Hypertens. 2022; 26(2): 45–59.
    CrossRef
  4. Małyszko J, Mastej M, Banach M, et al. Do we know more about hypertension in Poland after the May Measurement Month 2017?-Europe. Eur Heart J Suppl. 2019; 21(Suppl D): D97–D9D100.
    CrossRefPubMed
  5. Karczewska B, Bień B. Dementia in the aging population of Poland: challenges for medical and social care. Health Prob. Civil. 2019; 13(3): 161–169.
    CrossRef
  6. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020; 396(10248): 413–446.
    CrossRefPubMed
  7. Ungvari Z, Toth P, Tarantini S, et al. Hypertension-induced cognitive impairment: from pathophysiology to public health. Nat Rev Nephrol. 2021; 17(10): 639–654.
    CrossRefPubMed
  8. Takeda S, Rakugi H, Morishita R. Roles of vascular risk factors in the pathogenesis of dementia. Hypertens Res. 2020; 43(3): 162–167.
    CrossRefPubMed
  9. Armario P, Gómez-Choco M. Is it possible to prevent cognitive decline among middle-aged and older hypertensive individuals? Hypertens Res. 2022; 45(6): 1079–1081.
    CrossRefPubMed
  10. Jung H, Yang PS, Kim D, et al. Associations of hypertension burden on subsequent dementia: a population-based cohort study. Sci Rep. 2021; 11(1): 12291.
    CrossRefPubMed
  11. Messerli FH, Streit S, Grodzicki T. The oldest old: does hypertension become essential again? Eur Heart J. 2018; 39(33): 3144–3146.
    CrossRefPubMed
  12. Li C, Zhu Y, Ma Y, et al. Association of cumulative blood pressure with cognitive decline, dementia, and mortality. J Am Coll Cardiol. 2022; 79(14): 1321–1335.
    CrossRefPubMed
  13. McGrath ER, Beiser AS, DeCarli C, et al. Blood pressure from mid- to late life and risk of incident dementia. Neurology. 2017; 89(24): 2447–2454.
    CrossRefPubMed
  14. Gottesman RF, Schneider ALC, Albert M, et al. Midlife hypertension and 20-year cognitive change: the atherosclerosis risk in communities neurocognitive study. JAMA Neurol. 2014; 71(10): 1218–1227.
    CrossRefPubMed
  15. Mahinrad S, Kurian S, Garner CR, et al. Cumulative blood pressure exposure during young adulthood and mobility and cognitive function in midlife. Circulation. 2020; 141(9): 712–724.
    CrossRefPubMed
  16. Ou YN, Tan CC, Shen XN, et al. Blood pressure and risks of cognitive impairment and dementia: a systematic review and meta-analysis of 209 prospective studies. Hypertension. 2020; 76(1): 217–225.
    CrossRefPubMed
  17. Peters R, Beckett N, Fagard R, et al. Increased pulse pressure linked to dementia: further results from the Hypertension in the Very Elderly Trial — HYVET. J Hypertens. 2013; 31(9): 1868–1875.
    CrossRefPubMed
  18. Zhou R, Wei S, Wang Y, et al. Pulse pressure is associated with rapid cognitive decline over 4 years: a population-based cohort study. Brain Sci. 2022; 12(12).
    CrossRefPubMed
  19. Jung Y, Choi DW, Park S, et al. Association between pulse pressure and onset of dementia in an elderly Korean population: a cohort study. Int J Environ Res Public Health. 2020; 17(5).
    CrossRefPubMed
  20. Sha T, Cheng W, Yan Y. Prospective associations between pulse pressure and cognitive performance in Chinese middle-aged and older population across a 5-year study period. Alzheimers Res Ther. 2018; 10(1): 29.
    CrossRefPubMed
  21. Waldstein SR, Rice SC, Thayer JF, et al. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging. Hypertension. 2008; 51(1): 99–104.
    CrossRefPubMed
  22. Zang J, Shi J, Liang J, et al. Pulse pressure, cognition, and white matter lesions: a mediation analysis. Front Cardiovasc Med. 2021; 8: 654522.
    CrossRefPubMed
  23. Liu L, Hayden KM, May NS, et al. Association between blood pressure levels and cognitive impairment in older women: a prospective analysis of the Women's Health Initiative Memory Study. Lancet Healthy Longev. 2022; 3(1): e42–e53.
    CrossRefPubMed
  24. Liu Q, Fang J, Cui C, et al. Association of aortic stiffness and cognitive decline: a systematic review and meta-analysis. Front Aging Neurosci. 2021; 13: 680205.
    CrossRefPubMed
  25. Alvarez-Bueno C, Cunha PG, Martinez-Vizcaino V, et al. Arterial stiffness and cognition among adults: a systematic review and meta-analysis of observational and longitudinal studies. J Am Heart Assoc. 2020; 9(5): e014621.
    CrossRefPubMed
  26. Zhou TL, Kroon AA, van Sloten TT, et al. Greater blood pressure variability is associated with lower cognitive performance. Hypertension. 2019; 73(4): 803–811.
    CrossRefPubMed
  27. Yoo JE, Shin DW, Han K, et al. Blood pressure variability and the risk of dementia: a nationwide cohort study. Hypertension. 2020; 75(4): 982–990.
    CrossRefPubMed
  28. Jia P, Lee HWY, Chan JYC, et al. Long-term blood pressure variability increases risks of dementia and cognitive decline: a meta-analysis of longitudinal studies. Hypertension. 2021; 78(4): 996–1004.
    CrossRefPubMed
  29. de Heus RAA, Tzourio C, Lee EJ, et al. VARIABLE BRAIN Consortium. Association between blood prressure variability with dementia and cognitive impairment: a systematic review and meta-analysis. Hypertension. 2021; 78(5): 1478–1489.
    CrossRefPubMed
  30. Sible IJ, Yew B, Jang JY, et al. Blood pressure variability and plasma Alzheimer's disease biomarkers in older adults. Sci Rep. 2022; 12(1): 17197.
    CrossRefPubMed
  31. Fujiwara T, Hoshide S, Kanegae H, et al. Exaggerated blood pressure variability is associated with memory impairment in very elderly patients. J Clin Hypertens (Greenwich). 2018; 20(4): 637–644.
    CrossRefPubMed
  32. Wolters FJ, Mattace-Raso FUS, Koudstaal PJ, et al. Heart Brain Connection Collaborative Research Group. Orthostatic hypotension and the long-term risk of dementia: a population-based study. PLoS Med. 2016; 13(10): e1002143.
    CrossRefPubMed
  33. Min M, Shi T, Sun C, et al. The association between orthostatic hypotension and cognition and stroke: a meta-analysis of prospective cohort studies. Blood Press. 2020; 29(1): 3–12.
    CrossRefPubMed
  34. Peters R, Anstey KJ, Booth A, et al. Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort. Eur Heart J. 2018; 39(33): 3135–3143.
    CrossRefPubMed
  35. Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet. 2021; 398(10305): 1053–1064.
    CrossRefPubMed
  36. Kuźma E, Lourida I, Moore SF, et al. Stroke and dementia risk: a systematic review and meta-analysis. Alzheimers Dement. 2018; 14(11): 1416–1426.
    CrossRefPubMed
  37. Sexton E, McLoughlin A, Williams DJ, et al. Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke. Eur Stroke J. 2019; 4(2): 160–171.
    CrossRefPubMed
  38. Qin J, He Z, Wu L, et al. Prevalence of mild cognitive impairment in patients with hypertension: a systematic review and meta-analysis. Hypertens Res. 2021; 44(10): 1251–1260.
    CrossRefPubMed
  39. Ding J, Davis-Plourde KL, Sedaghat S, et al. Antihypertensive medications and risk for incident dementia and Alzheimer's disease: a meta-analysis of individual participant data from prospective cohort studies. Lancet Neurol. 2020; 19(1): 61–70.
    CrossRefPubMed
  40. Hughes D, Judge C, Murphy R, et al. Association of blood pressure lowering with incident dementia or cognitive impairment: a systematic review and meta-analysis. JAMA. 2020; 323(19): 1934–1944.
    CrossRefPubMed
  41. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 13 - benefits and adverse events in older and younger patients with hypertension: overview, meta-analyses and meta-regression analyses of randomized trials. J Hypertens. 2018; 36(8): 1622–1636.
    CrossRefPubMed
  42. Tykarski A, Filipiak KJ, Januszewicz A, et al. Zasady postępowania w nadciśnieniu tętniczym — 2019 rok. Nadciśnienie Tętnicze w Praktyce. 2019; 5(1): 1–86.
  43. Bavishi C, Bangalore S, Messerli FH. Outcomes of intensive blood pressure lowering in older hypertensive patients. J Am Coll Cardiol. 2017; 69(5): 486–493.
    CrossRefPubMed
  44. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 13 - benefits and adverse events in older and younger patients with hypertension: overview, meta-analyses and meta-regression analyses of randomized trials. J Hypertens. 2018; 36(8): 1622–1636.
    CrossRefPubMed
  45. Dallaire-Théroux C, Quesnel-Olivo MH, Brochu K, et al. Evaluation of intensive vs standard blood pressure reduction and association with cognitive decline and dementia: a systematic review and meta-analysis. JAMA Netw Open. 2021; 4(11): e2134553.
    CrossRefPubMed
  46. den Brok MG, van Dalen JW, Abdulrahman H, et al. Antihypertensive medication classes and the risk of dementia: a systematic review and network meta-analysis. J Am Med Dir Assoc. 2021; 22(7): 1386–1395.e15.
    CrossRefPubMed
  47. Adesuyan M, Jani YH, Alsugeir D, et al. Antihypertensive agents and incident Alzheimer's disease: a systematic review and meta-analysis of observational studies. J Prev Alzheimers Dis. 2022; 9(4): 715–724.
    CrossRefPubMed
  48. Levi Marpillat N, Macquin-Mavier I, Tropeano AI, et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens. 2013; 31(6): 1073–1082.
    CrossRefPubMed
  49. van Middelaar T, van Vught LA, Moll van Charante EP, et al. Lower dementia risk with different classes of antihypertensive medication in older patients. J Hypertens. 2017; 35(10): 2095–2101.
    CrossRefPubMed
  50. van Dalen JW, Marcum ZA, Gray SL, et al. Association of angiotensin II-stimulating antihypertensive use and dementia risk: post hoc analysis of the PreDIVA Trial. Neurology. 2021; 96(1): e67–e80.
    CrossRefPubMed
  51. Rouch L, Cestac P, Hanon O, et al. Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs. 2015; 29(2): 113–130.
    CrossRefPubMed
  52. Schroevers JL, Eggink E, Hoevenaar-Blom MP, et al. Antihypertensive medication classes and the risk of dementia over a decade of follow-up. J Hypertens. 2023; 41(2): 262–270.
    CrossRefPubMed
  53. Feldman L, Vinker S, Efrati S, et al. Amlodipine treatment of hypertension associates with a decreased dementia risk. Clin Exp Hypertens. 2016; 38(6): 545–549.
    CrossRefPubMed
  54. Calhoun DA, Lacourcière Y, Chiang YT, et al. Triple antihypertensive therapy with amlodipine, valsartan, and hydrochlorothiazide: a randomized clinical trial. Hypertension. 2009; 54(1): 32–39.
    CrossRefPubMed
  55. Assaad-Khalil SH, Najem R, Sison J, et al. Real-world effectiveness of amlodipine/valsartan and amlodipine/valsartan/hydrochlorothiazide in high-risk patients and other subgroups. Vasc Health Risk Manag. 2015; 11: 71–78.
    CrossRefPubMed
  56. Hu D, Liu L, Li W. Efficacy and safety of valsartan/amlodipine single-pill combination in 11,422 Chinese patients with hypertension: an observational study. Adv Ther. 2014; 31(7): 762–775.
    CrossRefPubMed
  57. Boutouyrie P, Achouba A, Trunet P, et al. EXPLOR Trialist Group. Amlodipine-valsartan combination decreases central systolic blood pressure more effectively than the amlodipine-atenolol combination: the EXPLOR study. Hypertension. 2010; 55(6): 1314–1322.
    CrossRefPubMed
  58. Sison J, Vega RM, Dayi Hu, et al. Efficacy and effectiveness of valsartan/amlodipine and valsartan/amlodipine/hydrochlorothiazide in hypertension: randomized controlled versus observational studies. Curr Med Res Opin. 2018; 34(3): 501–515.
    CrossRefPubMed
  59. Eckert S, Freytag SB, Müller A, et al. Meta-analysis of three observational studies of amlodipine/valsartan in hypertensive patients with additional risk factors. Blood Press. 2013; 22(Suppl 1): 11–21.
    CrossRefPubMed
  60. Yin G, Li Y, Xu W, et al. Chart review of patients receiving valsartan-amlodipine single-pill combination versus valsartan and amlodipine combination for blood pressure goal achievement and effects on the Hamilton anxiety rating/Hamilton depression rating scales. Medicine (Baltimore). 2019; 98(51): e18471.
    CrossRefPubMed
  61. Shi R, Chen X. Impacts of amlodipine, valsartan and two drugs combination on blood pressure variability and pulse wave velocity. J Hypertens. 2015; 33: 161.
  62. Xu SK, Huang QF, Zeng WF, et al. A randomized multicenter study on ambulatory blood pressure and arterial stiffness in patients treated with valsartan/amlodipine or nifedipine GITS. J Clin Hypertens (Greenwich). 2019; 21(2): 252–261.
    CrossRefPubMed
  63. Xu SK, Zeng WF, Li Y, et al. Effects of the valsartan/amlodipine combination and nifedipine gastrointestinal therapeutic system monotherapy on brachial pulse pressure and radial augmentation index in hypertensive patients. Blood Press Monit. 2021; 26(4): 251–256.
    CrossRefPubMed
  64. Sultan EZM, Rabea H, Elberry AA, et al. Effect of amlodipine/nebivolol combination therapy on central BP and PWV compared to Amlodipine/Valsartan combination therapy. Egypt Heart J. 2022; 74(1): 15.
    CrossRefPubMed
  65. Chen X, Huang Bo, Liu M, et al. Effects of different types of antihypertensive agents on arterial stiffness: a systematic review and meta-analysis of randomized controlled trials. J Thorac Dis. 2015; 7(12): 2339–2347.
    CrossRefPubMed
  66. Webb AJ, Rothwell PM. Effect of dose and combination of antihypertensives on interindividual blood pressure variability: a systematic review. Stroke. 2011; 42(10): 2860–2865.
    CrossRefPubMed
  67. Levi-Marpillat N, Macquin-Mavier I, Tropeano AI, et al. Antihypertensive drug classes have different effects on short-term blood pressure variability in essential hypertension. Hypertens Res. 2014; 37(6): 585–590.
    CrossRefPubMed
  68. Zhang Yi, Agnoletti D, Safar ME, et al. Effect of antihypertensive agents on blood pressure variability: the Natrilix SR versus candesartan and amlodipine in the reduction of systolic blood pressure in hypertensive patients (X-CELLENT) study. Hypertension. 2011; 58(2): 155–160.
    CrossRefPubMed
  69. Taha N, Shehata S, Abu-Zied M. P1651Combination of valsartan/amlodipine is more effective than bisoprolol/hydrochlorothiazide on reduction of blood pressure variability in patients with moderate or severe hypertension after control. Eur Heart J. 2017; 38(Suppl_1).
    CrossRef
  70. Biaggioni I. Orthostatic hypotension in the hypertensive patient. Am J Hypertens. 2018; 31(12): 1255–1259.
    CrossRefPubMed
  71. Rivasi G, Rafanelli M, Mossello E, et al. Drug-related orthostatic hypotension: beyond anti-hypertensive medications. Drugs Aging. 2020; 37(10): 725–738.
    CrossRefPubMed
  72. Allemann Y, Fraile B, Lambert M, et al. Efficacy of the combination of amlodipine and valsartan in patients with hypertension uncontrolled with previous monotherapy: the Exforge in Failure after Single Therapy (EX-FAST) study. J Clin Hypertens (Greenwich). 2008; 10(3): 185–194.
    CrossRefPubMed
  73. Smith TR, Philipp T, Vaisse B, et al. Amlodipine and valsartan combined and as monotherapy in stage 2, elderly, and black hypertensive patients: subgroup analyses of 2 randomized, placebo-controlled studies. J Clin Hypertens (Greenwich). 2007; 9(5): 355–364.
    CrossRefPubMed
  74. Bhanu C, Nimmons D, Petersen I, et al. Drug-induced orthostatic hypotension: a systematic review and meta-analysis of randomised controlled trials. PLoS Med. 2021; 18(11): e1003821.
    CrossRefPubMed
  75. Ma J, Wang XY, Hu ZD, et al. Meta-analysis of the efficacy and safety of adding an angiotensin receptor blocker (ARB) to a calcium channel blocker (CCB) following ineffective CCB monotherapy. J Thorac Dis. 2015; 7(12): 2243–2252.
    CrossRefPubMed
  76. Di Stefano C, Milazzo V, Totaro S, et al. Orthostatic hypotension in a cohort of hypertensive patients referring to a hypertension clinic. J Hum Hypertens. 2015; 29(10): 599–603.
    CrossRefPubMed
  77. Juraschek SP, Simpson LM, Davis BR, et al. Effects of antihypertensive class on falls, syncope, and orthostatic hypotension in older wdults: the ALLHAT trial. Hypertension. 2019; 74(4): 1033–1040.
    CrossRefPubMed
  78. Mukete BN, Cassidy M, Ferdinand KC, et al. Long-term anti-hypertensive therapy and stroke prevention: a meta-analysis. Am J Cardiovasc Drugs. 2015; 15(4): 243–257.
    CrossRefPubMed
  79. Wang JG, Li Y, Franklin SS, et al. Prevention of stroke and myocardial infarction by amlodipine and angiotensin receptor blockers: a quantitative overview. Hypertension. 2007; 50(1): 181–188.
    CrossRefPubMed
  80. Wanas Y, Bashir R, Islam N, et al. Assessing the risk of angiotensin receptor blockers on major cardiovascular events: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2020; 20(1): 188.
    CrossRefPubMed
  81. Savarese G, Costanzo P, Cleland JG, et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Cardiol. 2013; 61(2): 131–142.
    CrossRefPubMed
  82. Alosaimi M, Roos N, Alnakhli A, et al. Angiotensin-converting enzyme inhibitors nad angiotensin receptor blockers in stroke prevention: a systematic review and meta-analysis involving 297,451 patients. Journal of Hypertension. 2021; 39(Suppl 1): e184.
    CrossRef
  83. McMurray J, Solomon S, Pieper K, et al. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol. 2006; 47(4): 726–733.
    CrossRefPubMed
  84. Zhong XL, Dong Yi, Xu W, et al. Role of blood pressure management in stroke prevention: a systematic review and network meta-analysis of 93 Randomized Controlled Trials. J Stroke. 2021; 23(1): 1–11.
    CrossRefPubMed
  85. Lee HJ, Jang SI, Park EC. Effect of adherence to antihypertensive medication on stroke incidence in patients with hypertension: a population-based retrospective cohort study. BMJ Open. 2017; 7(6): e014486.
    CrossRefPubMed
  86. Chang TE, Ritchey MD, Park S, et al. National rates of nonadherence to antihypertensive medications among insured adults with hypertension, 2015. Hypertension. 2019; 74(6): 1324–1332.
    CrossRefPubMed
  87. Tsioufis K, Kreutz R, Sykara G, et al. Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature. J Hypertens. 2020; 38(6): 1016–1028.
    CrossRefPubMed
  88. Marcum ZA, Walker RL, Jones BL, et al. Patterns of antihypertensive and statin adherence prior to dementia: findings from the adult changes in thought study. BMC Geriatr. 2019; 19(1): 41.
    CrossRefPubMed
  89. Surma S. Od klasyki do nowoczesności. Teoria kontinuum sercowo-naczyniowego a rozwój farmakoterapii. Choroby Serca i Naczyń. 2022; 18(4): 200–218.
    CrossRef

Informacje o plikach cookie

Niezbędne pliki cookie

Zawsze aktywne

Te pliki cookie są niezbędne do prawidłowego wyświetlania i działania strony internetowej. Zablokowanie ich może spowodować nieprawidłowe działanie strony.

Analityczne pliki cookie

W ramach naszej strony internetowej korzystamy z narzędzi analitycznych, takich jak Google Analytics, które umożliwiają nam weryfikację ruchu na stronie internetowej. Narzędzia te mogą wymagać użycia plików cookie.

Społecznościowe pliki cookie

Są to pliki cookie powiązane z portalami społecznościowymi, z których korzystamy. Zaakceptowanie ich pozwoli na powiązanie Twojej wizyty na stronie z naszymi profilami w mediach społecznościowych.

Marketingowe pliki cookie

Są to pliki cookie odpowiedzialne za prowadzenie działań reklamowych i marketingowych - zgoda na ich wykorzystanie pozwoli nam kierować do Ciebie reklamy, bazujące na podstawie Twoich wcześniejszych aktywności w ramach naszej stronie internetowej.

Copyright © 2023-2024 Via Medica Regulamin Polityka cookies Polityka prywatności Nota prawna