Ferdinand Keith C, Taylor Cheryl
Division of Cardiology Emory University School of Medicine, Atlanta, Georgia 30349, USA.
Clin Cornerstone. 2009;9 Suppl 3:S5-17. doi: 10.1016/s1098-3597(09)60014-4.
Angiotensin receptor blockers (ARBs) are the most recently approved major class of antihypertensive agents. The primary mechanism of action of ARBs is the selective blockade of the AT(1) receptor. There are 7 ARBs presently approved for clinical use in the United States, several with other indications in addition to blood pressure reduction in patients with hypertension. While ARBs appear to be no more potent than angiotensin-converting enzyme inhibitors for lowering blood pressure when used as monotherapy, they are a beneficial alternative and even compelling in certain populations. This class of agents also has the added benefit of placebo-like side effects, potentially enhancing adherence. In this review, studies are presented as positive evidence supporting the use of ARBs in special populations (including persons with diabetic nephropathy), in patients with heart failure (especially with systolic dysfunction), for cardioprotection in high-risk cardiac patients (including postmyocardial infarction and stroke), and for delaying new-onset diabetes. Clinical information on the effects of ARBs related to race and ethnicity are also discussed, although the data in most large trials are not substantial. Despite the fact that African American patients have the highest prevalence of hypertension (with increased mortality and morbidity), studies have been less robust regarding ARBs and protection against cardiovascular disease in this population. Although at least 1 major study has confirmed the benefit of ARBs in Asian patients with diabetic nephropathy, overall, treating patients based on race and ethnicity remains fraught with difficulty.
血管紧张素受体阻滞剂（ARBs）是最近获批的主要一类抗高血压药物。ARBs的主要作用机制是选择性阻断AT(1)受体。目前在美国有7种ARBs被批准用于临床，其中几种除了可降低高血压患者的血压外，还有其他适应证。虽然ARBs作为单一疗法使用时，在降低血压方面似乎并不比血管紧张素转换酶抑制剂更有效，但它们是一种有益的替代药物，在某些人群中甚至更具优势。这类药物还具有类似安慰剂的副作用这一额外益处，可能会提高患者的依从性。在本综述中，将介绍一些研究，作为支持在特殊人群（包括糖尿病肾病患者）、心力衰竭患者（尤其是收缩功能障碍患者）、高危心脏病患者（包括心肌梗死后和中风患者）中使用ARBs进行心脏保护以及延缓新发糖尿病的阳性证据。还将讨论ARBs与种族和民族相关效应的临床信息，尽管大多数大型试验中的数据并不充分。尽管非裔美国患者的高血压患病率最高（死亡率和发病率也更高），但关于ARBs在该人群中预防心血管疾病的研究却不够充分。虽然至少有一项主要研究证实了ARBs对亚洲糖尿病肾病患者有益，但总体而言，根据种族和民族来治疗患者仍然充满困难。
