Reiser Jochen, Mundel Peter
Division of Nephrology, Program in Glomerular Disease, Massachusetts General Hospital and Harvard Medical School, CNY-149, 13th Street, Suite 8214, Boston, MA 02129, USA.
Curr Hypertens Rep. 2007 Nov;9(5):403-8. doi: 10.1007/s11906-007-0074-7.
There is no question about the contributory risk of hypertension in morbidity and mortality from cardiovascular (CV) disease and chronic kidney disease (CKD). Another independent risk factor for CV disease and CKD is proteinuria, which is most commonly caused by dysfunction of the kidney glomerular filter, in particular of the podocyte. Podocytes are highly differentiated pericyte-like cells that are essential to normal kidney function. Moreover, loss of podocytes is a hallmark of diabetic and nondiabetic progressive CKD. Recent data point to an important role for the renin-angiotensin system (RAS) and calcium signaling in the structural and functional integrity of podocytes. Given this scenario, it is desirable to treat hypertension with agents targeting the RAS, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (Ang II) type 1-receptor blockers (ARB). These agents have proven effects on lowering blood pressure (BP) and can reduce podocyte injury. Here we review the dual effects of RAS blockade on BP and on podocyte function and emphasize BP-dependent and BP-independent effects of this regimen.
高血压在心血管（CV）疾病和慢性肾脏病（CKD）的发病和死亡中所起的促成风险是毋庸置疑的。CV疾病和CKD的另一个独立风险因素是蛋白尿，其最常见的病因是肾小球滤过功能障碍，尤其是足细胞功能障碍。足细胞是高度分化的类周细胞，对正常肾功能至关重要。此外，足细胞丢失是糖尿病和非糖尿病性进行性CKD的一个标志。最近的数据表明，肾素-血管紧张素系统（RAS）和钙信号在足细胞的结构和功能完整性中起重要作用。在这种情况下，使用针对RAS的药物（如血管紧张素转换酶（ACE）抑制剂和血管紧张素II（Ang II）1型受体阻滞剂（ARB））来治疗高血压是可取的。这些药物已被证明有降低血压（BP）的作用，并且可以减少足细胞损伤。在此，我们综述RAS阻断对血压和足细胞功能的双重作用，并强调该治疗方案的血压依赖性和非血压依赖性作用。
