Weinberg Marc S, Kaperonis Nicholas, Bakris George L
Hypertension Clinical Research Center, Rush-Presbyterian-St. Luke's Medical Center, 1700 W. Van Buren, Suite 470, Chicago, IL 60612, USA.
Curr Hypertens Rep. 2003 Oct;5(5):418-25. doi: 10.1007/s11906-003-0088-8.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), two drug classes that effectively block the actions of the renin-angiotensin system (RAS), have unique capabilities as antihypertensive agents. Recent landmark clinical trials have demonstrated their important roles as primary therapy for the prevention of renal disease in diabetes. The optimal dosage of these RAS blockers required to slow the progression of renal disease or impair the development of cardiovascular risk is not known. However, data from many studies strongly support the use of the higher doses of ACE inhibitors or ARBs to reduce proteinuria. All studies of kidney disease progression demonstrate benefit on slowing only when blood pressure is reduced when using higher doses. In order to accrue the optimum benefit from ACE inhibitors and ARBs, the dose-response relationship for diabetic renal disease will have to be determined. The best strategy, ie, supramaximal doses of ACE inhibitors or ARBs or combining them, is still a matter of debate but may be resolved soon by results of ongoing studies.
血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）是两类能有效阻断肾素-血管紧张素系统（RAS）作用的药物，作为抗高血压药物具有独特的功效。近期具有里程碑意义的临床试验已证明它们作为糖尿病肾病预防的一线治疗方法具有重要作用。减缓肾病进展或降低心血管疾病风险所需的这些RAS阻滞剂的最佳剂量尚不清楚。然而，许多研究数据有力地支持使用更高剂量的ACE抑制剂或ARB来减少蛋白尿。所有关于肾病进展的研究均表明，仅在使用更高剂量使血压降低时才对减缓病情有益。为了从ACE抑制剂和ARB中获得最佳益处，必须确定糖尿病肾病的剂量反应关系。最佳策略，即使用ACE抑制剂或ARB的超最大剂量或联合使用，仍存在争议，但可能会很快由正在进行的研究结果来解决。
