Song Joon Ho, Cha Seok Ho, Hong Seong Bin, Kim Dae Hyeok
Division of Nephrology and Hypertension, Inha University College of Medicine, Incheon, Korea.
J Hypertens Suppl. 2006 Mar;24(1):S101-6. doi: 10.1097/01.hjh.0000220414.99610.6b.
Despite the renoprotective effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), many patients with chronic kidney disease develop end-stage kidney disease. Combination treatment with an ACEI and an ARB is a recently introduced approach to obtain more complete blockade of the renin-angiotensin system, based on the different mechanisms of action of the two classes of drug. To assess the shortcomings of single treatment with ACEIs and ARBs, and the potential benefits of combination treatment, we reviewed the experimental and clinical evidence suggesting that combination treatment offers more complete blockade of the renin-angiotensin system and identified areas in which further research is necessary to confirm the benefits of combination treatment. The available data suggest that combination treatment with an ACEI and an ARB has a greater renoprotective effect than either drug alone. In addition, more recent data have shown that combination treatment is more potent in suppressing renal fibrosis, and is well tolerated in patients with advanced chronic kidney disease. Clinical trials with rigorous endpoints are needed to further establish the benefits of combination treatment in renal protection.
尽管血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）具有肾脏保护作用，但许多慢性肾病患者仍会发展为终末期肾病。基于这两类药物不同的作用机制，联合使用ACEI和ARB是一种最近引入的旨在更全面阻断肾素-血管紧张素系统的方法。为了评估单独使用ACEI和ARB治疗的缺点以及联合治疗的潜在益处，我们回顾了实验和临床证据，这些证据表明联合治疗能更全面地阻断肾素-血管紧张素系统，并确定了需要进一步研究以证实联合治疗益处的领域。现有数据表明，联合使用ACEI和ARB比单独使用任何一种药物具有更强的肾脏保护作用。此外，最新数据显示联合治疗在抑制肾纤维化方面更有效，并且在晚期慢性肾病患者中耐受性良好。需要进行具有严格终点的临床试验，以进一步确定联合治疗在肾脏保护方面的益处。
