Neldam Steen
Rødovre Centrum 294, DK-2610 Rødovre, Denmark.
Future Cardiol. 2010 Jan;6(1):129-35. doi: 10.2217/fca.09.61.
Angiotensin-receptor blockers (ARBs) offer superior tolerability to angiotensin-converting enzyme inhibitors, and are increasingly used in patient management. ARBs vary in their pharmacological profiles, which results in efficacy differences. Therefore, deciding between ARBs should be evidence-based and related to the specific requirements of the individual patient. For patients with hypertension but at low additional risk, an ARB that provides sustained, powerful 24-h reductions in blood pressure is suitable. For patients at very high additional risk (with heart failure), an ARB with demonstrated efficacy in this patient population is the preferred option. For patients at increased risk, telmisartan should be the ARB of choice based on the results from the Ongoing Telmisartan Alone and in Combination with Ramipril Global End Point Trial (ONTARGET), which demonstrated for the first time that an ARB has equivalent protection to the reference angiotensin-converting enzyme inhibitor in a broad cross-section of at-risk patients but a better side-effect profile.
血管紧张素受体阻滞剂（ARBs）比血管紧张素转换酶抑制剂具有更好的耐受性，并且在患者管理中使用越来越广泛。ARBs的药理特性各不相同，这导致了疗效差异。因此，在不同ARBs之间做出选择应该基于证据，并与个体患者的具体需求相关。对于高血压但额外风险较低的患者，选择一种能在24小时内持续、强效降低血压的ARB是合适的。对于额外风险非常高（患有心力衰竭）的患者，一种在该患者群体中已证明有疗效的ARB是首选。对于风险增加的患者，基于缬沙坦单药及与雷米普利联合应用全球终点试验（ONTARGET）的结果，替米沙坦应该是ARB的首选，该试验首次证明，在广泛的高危患者群体中，一种ARB与作为对照的血管紧张素转换酶抑制剂具有同等的保护作用，但副作用更少。
