Santamaría Olmo R
Servicio de Nefrologia, Hospital Universitario Reina Sofia, Cordoba, Spain.
Nefrologia. 2008;28 Suppl 5:131-7.
Arterial hypertension is one of the major risk factors for the development of cardiovascular diseases such as heart failure, ischemic heart disease, chronic kidney disease and cerebrovascular events. Adequate blood pressure control is vital for the management of patients with vascular disease. New therapeutic alternatives are appearing on the horizon to improve the degree of blood pressure control in these patients, such as direct renin inhibitors, beta-blockers with additional properties, carotid receptor- stimulating devices and vaccination against arterial hypertension. Direct renin inhibitors are a new family of antihypertensive drugs that have so far shown a good antihypertensive effect and an additive effect on reduction of proteinuria in patients with diabetic nephropathy. Recent meta-analyses suggest that betablockers used as first-line treatment for uncomplicated arterial hypertension could have a less beneficial effect on the development of cardiovascular disease than other antihypertensive drugs. However, the emergence of new subtypes of beta-blockers with other hemodynamic and metabolic properties could change this conception. Carotid receptor-stimulating devices and vaccination against arterial hypertension, although not totally new therapies, are being revitalized, with preliminary results that suggest that they could be used for the treatment of arterial hypertension in patients with a specific profile. Although scientifically stimulating, the long-term beneficial effects of these new therapeutic alternatives on target-organ protection still need to be confirmed.
动脉高血压是诸如心力衰竭、缺血性心脏病、慢性肾脏病和脑血管事件等心血管疾病发生的主要危险因素之一。对血管疾病患者的管理而言,充分控制血压至关重要。新的治疗选择正在出现,以提高这些患者的血压控制程度,如直接肾素抑制剂、具有附加特性的β受体阻滞剂、颈动脉受体刺激装置和抗动脉高血压疫苗。直接肾素抑制剂是一类新型抗高血压药物,迄今为止已显示出良好的降压效果,并对糖尿病肾病患者降低蛋白尿具有相加作用。最近的荟萃分析表明,作为单纯性动脉高血压一线治疗药物的β受体阻滞剂,对心血管疾病发生的有益作用可能不如其他抗高血压药物。然而,具有其他血流动力学和代谢特性的新型β受体阻滞剂的出现可能会改变这一观念。颈动脉受体刺激装置和抗动脉高血压疫苗虽然并非全新的疗法,但正在重新兴起,初步结果表明它们可用于特定类型患者的动脉高血压治疗。尽管这些新的治疗选择在科学上令人振奋,但其对靶器官保护的长期有益作用仍有待证实。