Fritsch Neves Mario, Schiffrin Ernesto L
Clinical Research Institute of Montreal, 110 Pine Avenue West, Montreal, Quebec, Canada H2W 1R7.
Curr Hypertens Rep. 2003 Feb;5(1):59-65. doi: 10.1007/s11906-003-0012-2.
Blockade of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor antagonists has resulted in beneficial effects in essential hypertensive patients. However, occurrence of cardiovascular events has not been appropriately controlled beyond a certain percentage. One reason could be the effects of aldosterone, the final component of the system. The aldosterone escape phenomenon could explain undesirable outcomes observed in hypertensive patients even under treatment with ACE inhibitors or angiotensin antagonists. Aldosterone has direct effects on the vasculature and has been associated with vascular smooth muscle cell hypertrophy, endothelial dysfunction, cardiac fibrosis, proteinuria, and renal vascular injury. Animal models and clinical trials have proven the benefit of aldosterone receptor antagonism. With increased recognition of the prevalence of hyperaldosteronism in patients thought to have "essential" hypertension, the use of drugs that block aldosterone action may become more widespread and protect the vasculature from the deleterious effects of aldosterone.
使用血管紧张素转换酶（ACE）抑制剂或血管紧张素受体拮抗剂阻断肾素-血管紧张素-醛固酮系统已在原发性高血压患者中产生有益效果。然而，心血管事件的发生率在超过一定比例后并未得到适当控制。一个原因可能是该系统的最终成分醛固酮的作用。醛固酮逃逸现象可以解释即使在使用ACE抑制剂或血管紧张素拮抗剂治疗的高血压患者中观察到的不良后果。醛固酮对血管系统有直接作用，并与血管平滑肌细胞肥大、内皮功能障碍、心脏纤维化、蛋白尿和肾血管损伤有关。动物模型和临床试验已证明醛固酮受体拮抗的益处。随着对被认为患有“原发性”高血压患者中醛固酮增多症患病率的认识增加，使用阻断醛固酮作用的药物可能会更广泛，并保护血管系统免受醛固酮的有害影响。
