Soberman Judith, Chafin Carol C, Weber Karl T
Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Dobbs Research Institute, Memphis 38163, USA.
Curr Opin Investig Drugs. 2002 Jul;3(7):1024-8.
The role of aldosterone in the pathophysiology of congestive heart failure (CHF) has long been recognized. The recent RALES (Randomized Aldactone Evaluation Study) trial demonstrated early reduction in morbidity and mortality using spironolactone, an aldosterone receptor antagonist, in combination with angiotensin converting enzyme (ACE) inhibitor and loop diuretic, in patients with heart failure. This effect of spironolactone highlighted the importance of understanding the contributions of the renin-angiotensin-aldosterone system (RAAS) in the progression of CHF, and increased interest in the use of aldosterone antagonists. While ACE inhibitors have had the largest impact on adverse events in CHF, numerous studies have shown that these drugs fail to completely suppress aldosterone. Blocking the effects of residual aldosterone has now been demonstrated to affect prognosis in these patients. This review will discuss the role of aldosterone in the pathophysiology of CHF, with an emphasis on both known and potential therapeutic benefits of aldosterone antagonism.
醛固酮在充血性心力衰竭（CHF）病理生理学中的作用早已得到认可。最近的RALES（随机螺内酯评估研究）试验表明，在心力衰竭患者中，使用醛固酮受体拮抗剂螺内酯联合血管紧张素转换酶（ACE）抑制剂和襻利尿剂，可早期降低发病率和死亡率。螺内酯的这种作用突出了理解肾素-血管紧张素-醛固酮系统（RAAS）在CHF进展中的作用的重要性，并增加了对使用醛固酮拮抗剂的兴趣。虽然ACE抑制剂对CHF不良事件的影响最大，但大量研究表明，这些药物无法完全抑制醛固酮。现已证明，阻断残余醛固酮的作用会影响这些患者的预后。本综述将讨论醛固酮在CHF病理生理学中的作用，重点关注醛固酮拮抗的已知和潜在治疗益处。
