Pimenta Eduardo, Oparil Suzanne
Endocrine Hypertension Research Center and Clinical Center of Research Excellence in Cardiovascular Disease and Metabolic Disorders, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Vasc Health Risk Manag. 2009;5(1):453-63. doi: 10.2147/vhrm.s4291.
The renin-angiotensin-aldosterone system (RAAS) is an important mediator of blood pressure (BP) and volume regulation in both normotensive and hypertensive persons and is a major contributor to hypertension-related target organ damage. The concept of renin inhibition for managing hypertension by blocking the RAAS pathway at its point of activation is very attractive since the renin-angiotensinogen reaction is the first and rate-limiting step in the generation of angiotensin II (Ang II). Aliskiren, the first in a new class of orally effective direct renin inhibitors (DRIs), is approved for the treatment of hypertension. It is effective in reducing BP in the general population of hypertensive patients and in special patient groups such as obese persons, and has a tolerability and safety profile similar to placebo. Aliskiren has renoprotective, cardioprotective and anti-atherosclerotic effects in animal models that appear to be independent of BP lowering. It reduces proteinuria in diabetic patients and has favorable neurohumoral effects in patients with symptomatic heart failure. Additional outcome trials are needed to establish the role of this novel class of antihypertensive medication in the therapeutic armamentarium.
肾素-血管紧张素-醛固酮系统（RAAS）是血压（BP）和容量调节的重要介质，在血压正常和高血压患者中均如此，并且是高血压相关靶器官损害的主要促成因素。通过在肾素-血管紧张素原反应这一血管紧张素II（Ang II）生成的起始和限速步骤阻断RAAS途径来应用肾素抑制治疗高血压的理念非常有吸引力。阿利吉仑是新型口服有效的直接肾素抑制剂（DRIs）中的首个药物，已被批准用于治疗高血压。它在高血压患者的普通人群以及肥胖者等特殊患者群体中均能有效降低血压，并且具有与安慰剂相似的耐受性和安全性。在动物模型中，阿利吉仑具有肾脏保护、心脏保护和抗动脉粥样硬化作用，这些作用似乎独立于血压降低。它可降低糖尿病患者的蛋白尿，并对有症状心力衰竭患者产生有利的神经体液效应。需要进行更多结局试验来确定这类新型抗高血压药物在治疗手段中的作用。
