Kim Young-Sin, Greenberg Barry
Advanced Heart Failure Treatment Program, University of California, San Diego, 200 West Arbor Street, San Diego, CA 92103, USA.
Curr Treat Options Cardiovasc Med. 2009 Dec;11(6):455-66. doi: 10.1007/s11936-009-0048-y.
There is convincing evidence that the renin-angiotensin-aldosterone system (RAAS) plays an important role in heart failure (HF), from the events that result in its inception through advanced disease. In particular, RAAS activation is one of the major pathways involved in maladaptive cardiac remodeling, a process that results in progressive cardiac dysfunction. Not surprisingly, strategies targeting the RAAS have substantial benefits in HF. These therapies, which include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists, have emerged as cornerstones of HF therapy, particularly in patients with systolic dysfunction. Their role in HF with preserved ejection fraction, however, is less certain. New information and approaches targeting RAAS activation continue to emerge. Direct renin inhibitors are hypothesized to have beneficial effects in HF, but further studies are needed to evaluate their efficacy.
有确凿证据表明，肾素 - 血管紧张素 - 醛固酮系统（RAAS）在心力衰竭（HF）中起重要作用，从导致其发病的事件到晚期疾病阶段皆是如此。特别是，RAAS激活是参与适应性不良心脏重塑的主要途径之一，这一过程会导致进行性心脏功能障碍。毫不奇怪，针对RAAS的策略在HF中具有显著益处。这些疗法包括血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和醛固酮受体拮抗剂，已成为HF治疗的基石，尤其是在收缩功能障碍患者中。然而，它们在射血分数保留的HF中的作用尚不确定。针对RAAS激活的新信息和方法不断涌现。直接肾素抑制剂被推测在HF中具有有益作用，但需要进一步研究来评估其疗效。
