Sureshkumar Kalathil K
Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Vasc Health Risk Manag. 2008;4(6):1205-20. doi: 10.2147/vhrm.s3364.
Hypertension is a major risk factor for the development of cardiovascular and renal disease. The incidence of hypertension is increasing globally and the rate of blood pressure control remains inadequate. Renin-angiotensin-aldosterone system (RAAS) plays a crucial role in volume regulation and maintenance of blood pressure. Pathological activation of RAAS results in chronic hypertension and consequent end organ damage. Most patients with hypertension require combination therapy using agents with complimentary mechanisms of action. Hydrochlorothiazide (HCTZ) together with an agent blocking the RAAS such as an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) are widely used effective anti-hypertensive therapy. Aliskiren is an orally effective direct renin inhibitor that blocks the generation of angiotensin I from angiotensinogen, the rate limiting step of RAAS activation. Studies have shown equivalent antihypertensive efficacy of aliskiren when compared to existing medications such as HCTZ, ACE inhibitors and ARBs. Aliskiren has also been tested in combination therapies. The current review aims to look at the efficacy of aliskiren therapy in hypertension and the evidence for using aliskiren in combination with HCTZ.
高血压是心血管疾病和肾脏疾病发生的主要危险因素。全球范围内高血压的发病率正在上升，而血压控制率仍然不足。肾素-血管紧张素-醛固酮系统（RAAS）在血容量调节和血压维持中起关键作用。RAAS的病理性激活会导致慢性高血压及随之而来的靶器官损害。大多数高血压患者需要联合使用具有互补作用机制的药物进行治疗。氢氯噻嗪（HCTZ）与一种阻断RAAS的药物，如血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）联合使用，是广泛应用的有效的抗高血压治疗方法。阿利吉仑是一种口服有效的直接肾素抑制剂，它能阻断血管紧张素原生成血管紧张素I，这是RAAS激活的限速步骤。研究表明，与氢氯噻嗪、ACE抑制剂和ARB等现有药物相比，阿利吉仑具有同等的降压疗效。阿利吉仑也已在联合治疗中进行了测试。本综述旨在探讨阿利吉仑治疗高血压的疗效以及阿利吉仑与氢氯噻嗪联合使用的证据。
