Cohn Jay N
Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
Am Heart J. 2006 Nov;152(5):859.e1-8. doi: 10.1016/j.ahj.2006.08.001.
The role of angiotensin II, the key mediator of the renin-angiotensin-aldosterone system, in the pathophysiology of cardiovascular disease is well known. Pharmacologic interruption of the activity of angiotensin II, either through blockade of the angiotensin receptor or inhibition of angiotensin-converting enzyme, is associated with a reduction in cardiovascular disease morbidity and mortality, as evidenced by accumulated data from large-scale, well-controlled clinical trials in high-risk populations. As the underlying mechanisms of vascular disease and the effects of blockade of the renin-angiotensin-aldosterone system on these processes have been further defined, the therapeutic focus has begun to shift toward prevention of disease progression at earlier stages. Continued research has identified early signs of vascular disease, such as endothelial dysfunction and vascular and cardiac remodeling, which occur long before clinical manifestations of cardiovascular disease become evident. Diagnostic tests are now available to assess otherwise healthy individuals for these signs. A preliminary trial is under way to evaluate the role of angiotensin receptor blockade as preventive treatment of individuals with early signs of vascular or cardiac disease.
肾素-血管紧张素-醛固酮系统的关键介质血管紧张素II在心血管疾病病理生理学中的作用是众所周知的。通过阻断血管紧张素受体或抑制血管紧张素转换酶对血管紧张素II的活性进行药物干预，与心血管疾病发病率和死亡率的降低相关，大规模、严格对照的高危人群临床试验积累的数据证明了这一点。随着血管疾病的潜在机制以及肾素-血管紧张素-醛固酮系统阻断对这些过程的影响得到进一步明确，治疗重点已开始转向在疾病早期预防疾病进展。持续的研究已经确定了血管疾病的早期迹象，如内皮功能障碍以及血管和心脏重塑，这些在心血管疾病的临床表现明显之前很久就会出现。现在有诊断测试可用于评估看似健康的个体是否存在这些迹象。一项初步试验正在进行中，以评估血管紧张素受体阻断作为有血管或心脏疾病早期迹象个体的预防性治疗的作用。
