Renin-angiotensin-aldosterone system blockade for cardiovascular diseases: current status

被引:268
作者
Ma, Terry K. W. [1 ]
Kam, Kevin K. H. [1 ]
Yan, Bryan P. [1 ]
Lam, Yat-Yin [1 ]
机构
[1] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China
关键词
renin-angiotensin-aldosterone system; angiotensin converting enzyme inhibitors; angiotensin II type 1 receptor blockers; hypertension; myocardial infarction; heart failure; stroke; diabetic nephropathy; CONVERTING-ENZYME-INHIBITOR; LEFT-VENTRICULAR DYSFUNCTION; ACUTE MYOCARDIAL-INFARCTION; CHRONIC HEART-FAILURE; CORONARY-ARTERY-DISEASE; AMINO ACID SEQUENCE; HIGH-RISK PATIENTS; DIABETIC-NEPHROPATHY; RECEPTOR BLOCKER; RANDOMIZED-TRIAL;
D O I
10.1111/j.1476-5381.2010.00750.x
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Activation of the renin-angiotensin-aldosterone system (RAAS) results in vasoconstriction, muscular (vascular and cardiac) hypertrophy and fibrosis. Established arterial stiffness and cardiac dysfunction are key factors contributing to subsequent cardiovascular and renal complications. Blockade of RAAS has been shown to be beneficial in patients with hypertension, acute myocardial infarction, chronic systolic heart failure, stroke and diabetic renal disease. An aggressive approach for more extensive RAAS blockade with combination of two commonly used RAAS blockers [ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)] yielded conflicting results in different patient populations. Combination therapy is also associated with more side effects, in particular hypotension, hyperkalaemia and renal impairment. Recently published ONTARGET study showed ACEI/ARB combination therapy was associated with more adverse effects without any increase in benefit. The Canadian Hypertension Education Program responded with a new warning: 'Do not use ACEI and ARB in combination'. However, the European Society of Cardiology in their updated heart failure treatment guidelines still recommended ACEI/ARB combo as a viable option. This apparent inconsistency among guidelines generates debate as to which approach of RAAS inhibition is the best. The current paper reviews the latest evidence of isolated ACEI or ARB use and their combination in cardiovascular diseases, and makes recommendations for their prescriptions in specific patient populations.
引用
收藏
页码:1273 / 1292
页数:20
相关论文
共 159 条
[1]   Anglotensin-converting enzyme inhibitors in coronary artery disease and preserved left ventricular systolic function - A systematic review and meta-analysis of randomized controlled trials [J].
Al-Mallah, MH ;
Tleyjeh, IM ;
Abdel-Latif, AA ;
Weaver, WD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 47 (08) :1576-1583
[2]   THE EFFECT OF THE ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR ZOFENOPRIL ON MORTALITY AND MORBIDITY AFTER ANTERIOR MYOCARDIAL-INFARCTION [J].
AMBROSIONI, E ;
BORGHI, C ;
MAGNANI, B .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (02) :80-85
[3]  
[Anonymous], 1992, NEW ENGL J MED, V327, P685, DOI [10.1056/NEJM199209033271003.Erratumin, DOI 10.1056/NEJM199209033271003]
[4]  
[Anonymous], 2004, AM J KIDNEY DIS S1
[5]   TRANSGENIC RATS CARRYING THE MOUSE RENIN GENE - MORPHOLOGICAL CHARACTERIZATION OF A LOW-RENIN HYPERTENSION MODEL [J].
BACHMANN, S ;
PETERS, J ;
ENGLER, E ;
GANTEN, D ;
MULLINS, J .
KIDNEY INTERNATIONAL, 1992, 41 (01) :24-36
[6]   Angiotensin II formation from ACE and chymase in human and animal hearts: methods and species considerations [J].
Balcells, E ;
Meng, QC ;
Johnson, WH ;
Oparil, S ;
DellItalia, LJ .
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1997, 273 (04) :H1769-H1774
[7]  
BALL SG, 1993, LANCET, V342, P821
[8]   Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy [J].
Barnett, AH ;
Bain, SC ;
Bouter, P ;
Karlberg, B ;
Madsbad, S ;
Jervell, J ;
Mustonen, J .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (19) :1952-1961
[9]   Augmented short- and long-term hemodynamic and hormonal effects of an angiotensin receptor blocker added to angiotensin converting enzyme inhibitor therapy in patients with heart failure [J].
Baruch, L ;
Anand, I ;
Cohen, IS ;
Ziesche, S ;
Judd, D ;
Cohn, JN .
CIRCULATION, 1999, 99 (20) :2658-2664
[10]   Treatment of hypertension in patients 80 years of age or older [J].
Beckett, Nigel S. ;
Peters, Ruth ;
Fletcher, Astrid E. ;
Staessen, Jan A. ;
Liu, Lisheng ;
Dumitrascu, Dan ;
Stoyanovsky, Vassil ;
Antikainen, Riitta L. ;
Nikitin, Yuri ;
Anderson, Craig ;
Belhani, Alli ;
Forette, Francoise ;
Rajkumar, Chakravarthi ;
Thijs, Lutgarde ;
Banya, Winston ;
Bulpitt, Christopher J. .
NEW ENGLAND JOURNAL OF MEDICINE, 2008, 358 (18) :1887-1898