Nickenig Georg, Ostergren Jan, Struijker-Boudier Harry
University of Saarland, Homburg, Germany.
J Renin Angiotensin Aldosterone Syst. 2006 Jun;7 Suppl 1:S1-7. doi: 10.3317/jraas.2006.017.
Targeting the renin-angiotensin-aldosterone system (RAAS), specifically the effector peptide angiotensin II (Ang II), represents a major opportunity for slowing the progression of cardiovascular disease (CVD) and, in turn, reducing the risk of morbidity and mortality. Inhibition of angiotensin-converting enzyme (ACE) and selective blockade of Ang II AT1 receptors are two approaches through which the pathophysiological effects of Ang II can be targeted. Numerous clinical studies have established the benefits of ACE inhibitors (ACE-Is) in lessening the morbidity and mortality burden of CVD. There are, however, tolerability concerns associated with ACE-Is, such as angioedema and dry cough. By blocking Ang II at the AT1 receptor level, Ang II receptor blockers (ARBs) provide a more specific and complete blockade of the deleterious effects of Ang II and tend to have more favourable tolerability. A number of clinical trials have shown that ARBs are not only associated with positive outcomes across the CVD continuum but mat also have a role in the prevention or delay of diabetes (a major cardiovascular risk factor). Ongoing trials are aiming to define the place of such agents in lessening morbidity and mortality from CVD.
针对肾素-血管紧张素-醛固酮系统（RAAS），特别是效应肽血管紧张素II（Ang II），是减缓心血管疾病（CVD）进展进而降低发病和死亡风险的一个主要契机。抑制血管紧张素转换酶（ACE）以及选择性阻断Ang II的AT1受体是两种可针对Ang II病理生理效应的方法。众多临床研究已证实血管紧张素转换酶抑制剂（ACE-Is）在减轻CVD发病和死亡负担方面的益处。然而，ACE-Is存在一些耐受性问题，如血管性水肿和干咳。通过在AT1受体水平阻断Ang II，血管紧张素II受体阻滞剂（ARBs）能更特异性、更完全地阻断Ang II的有害作用，且往往具有更良好的耐受性。多项临床试验表明，ARBs不仅在整个CVD病程中都与积极结果相关，而且在预防或延缓糖尿病（一种主要的心血管危险因素）方面也有作用。正在进行的试验旨在明确此类药物在降低CVD发病和死亡方面的地位。
