Basile Jan
Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston, SC 29401, USA.
Curr Atheroscler Rep. 2009 Sep;11(5):371-6. doi: 10.1007/s11883-009-0056-0.
Cardiovascular disease (CVD) accounts for one of every three deaths in the United States. In recent years, a greater understanding of the renin-angiotensin-aldosterone system's (RAAS) contribution to CVD, particularly in the area of blood pressure regulation, has emerged. Thus, interrupting or blocking the RAAS has become a key component in the treatment of hypertension and other cardiovascular conditions. The role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing CVD in high-risk populations has been demonstrated by two recently completed major trials: the Ongoing Telmisartan Alone and in Combination with Ramipril Global endpoint Trial (ONTARGET) and the Telmisartan Randomized Assessment Study in ACE-Intolerant Subjects with Cardiovascular Disease (TRANSCEND). This article describes these key studies and their outcomes and identifies critical issues that they raise for clinical practice in terms of choosing the most effective therapy for patients with existing CVD.
心血管疾病（CVD）在美国每三例死亡中就占一例。近年来，人们对肾素 - 血管紧张素 - 醛固酮系统（RAAS）在心血管疾病中的作用，尤其是在血压调节方面的作用，有了更深入的了解。因此，阻断或抑制RAAS已成为治疗高血压和其他心血管疾病的关键组成部分。两项近期完成的大型试验已证明血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂在降低高危人群心血管疾病风险方面的作用：缬沙坦单药及与雷米普利联合应用的全球终点试验（ONTARGET）和缬沙坦在不耐受血管紧张素转换酶的心血管疾病患者中的随机评估研究（TRANSCEND）。本文介绍了这些关键研究及其结果，并确定了它们在为现有心血管疾病患者选择最有效治疗方法方面给临床实践带来的关键问题。
