Reams G P
University of Missouri School of Medicine, Columbia.
Am J Cardiol. 1992 Apr 2;69(10):59C-64C. doi: 10.1016/0002-9149(92)90283-5.
In addition to the classic circulating renin-angiotensin system, increasing evidence supports the existence of local tissue renin-angiotensin systems (vascular, cardiac, kidney, and brain) that appear to participate in cardiovascular homeostasis and in the pathogenesis of cardiovascular disorders via multiple autocrine and paracrine functions. Components of local systems have been detected in cardiovascular tissues. Studies with angiotensin-converting enzyme (ACE) inhibitors provide further evidence of the existence and importance of tissue renin-angiotensin systems. The blood pressure-lowering effect of quinapril, for example, correlated better with inhibition of tissue ACE (aorta) than with inhibition of plasma ACE. The effects of ACE inhibitors on local tissue renin-angiotensin systems (vascular in particular) may be the crucial determinant of response to treatment. Newer ACE inhibitors, such as quinapril, have favorable side effect profiles as well as apparent tissue specificity for the vascular renin-angiotensin system (and possibly other relevant cardiovascular tissue). Differentiation among ACE inhibitors should play an even more important role in the future for individualization of therapy.
除了经典的循环肾素-血管紧张素系统外，越来越多的证据支持局部组织肾素-血管紧张素系统（血管、心脏、肾脏和大脑）的存在，这些系统似乎通过多种自分泌和旁分泌功能参与心血管稳态以及心血管疾病的发病机制。在心血管组织中已检测到局部系统的组成部分。使用血管紧张素转换酶（ACE）抑制剂的研究进一步证明了组织肾素-血管紧张素系统的存在及其重要性。例如，喹那普利的降压作用与抑制组织ACE（主动脉）的相关性比与抑制血浆ACE的相关性更好。ACE抑制剂对局部组织肾素-血管紧张素系统（尤其是血管）的作用可能是治疗反应的关键决定因素。新型ACE抑制剂，如喹那普利，具有良好的副作用谱，并且对血管肾素-血管紧张素系统（可能还有其他相关心血管组织）具有明显的组织特异性。未来，ACE抑制剂之间的差异对于个体化治疗应发挥更重要的作用。
