Basile Jan, Toth Peter P
Department of Medicine, Medical University of South Carolina, Charleston, USA.
South Med J. 2009 Oct;102(10 Suppl):S1-S12. doi: 10.1097/SMJ.0b013e3181ba0d8a.
The renin-angiotensin system (RAS) plays a central pathogenic role in the development of hypertension and associated vascular disorders. However, whether the two main classes of agents that blunt RAS activity-angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)-yield comparable cardioprotective and renoprotective effects in high-risk patients is controversial.
An analysis of several controlled clinical trials provides evidence that, in patients with or without heart failure, ARBs provide protective effects and improvements in prognosis compared with those achieved with ACEIs.
This article describes the critical studies that examine the cardioprotective and renoprotective efficacy of ARBs and identifies the populations and doses at which these agents are most effective.
In the clinical setting, ARBs may be a valuable alternative to ACEI therapy. Because of their tolerability profile, ARBs or ARB combination therapy may be an option for patients susceptible to ACEI-related adverse events.
肾素-血管紧张素系统（RAS）在高血压及相关血管疾病的发生发展中起核心致病作用。然而，两类抑制RAS活性的药物——血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）——在高危患者中是否产生相当的心脏保护和肾脏保护作用仍存在争议。
对多项对照临床试验的分析提供了证据，表明在有心衰或无心衰的患者中，与ACEI相比，ARB具有保护作用并能改善预后。
本文描述了检验ARB心脏保护和肾脏保护疗效的关键研究，并确定了这些药物最有效的人群和剂量。
在临床环境中，ARB可能是ACEI治疗的有价值替代方案。由于其耐受性，ARB或ARB联合治疗可能是易发生ACEI相关不良事件患者的一种选择。
