Oklahoma Cardiovascular and Hypertension Center and University of Oklahoma, Oklahoma City, Oklahoma, USA.
Am J Cardiol. 2010 Mar 15;105(6):849-52. doi: 10.1016/j.amjcard.2009.11.044.
Clinical and experimental studies have shown that the initial suppression of angiotensin II after the administration of angiotensin-converting enzyme (ACE) inhibitors is later reversed and returns almost to pretreatment levels. This raised the hypothesis of the "escape phenomenon," which was strengthened by the discovery that angiotensin II can also be generated through non-ACEs. Therefore, the addition of angiotensin receptor blockers to ACE inhibitors would produce additional benefits by blocking all angiotensin II at the angiotensin II receptor type 1 level and in addition allowing angiotensin II to stimulate the unoccupied angiotensin II receptor type 2, causing additional vasodilation and antiremodeling effects. However, analysis of various studies including hypertension, heart failure, and renal disease has demonstrated that the gain is modest when combining ACE inhibitors, angiotensin receptor blockers, or the renin blocker aliskiren. In conclusion, on the basis of the results of this analysis, dual blockade of the renin-angiotensin-aldosterone system should not be used for the treatment of hypertension, heart failure, and renal disease, with perhaps the exception of diabetic nephropathy with albuminuria, until additional information is provided from ongoing studies.
临床和实验研究表明，血管紧张素转换酶（ACE）抑制剂给药后，血管紧张素 II 的初始抑制作用随后被逆转，几乎恢复到治疗前的水平。这就提出了“逃逸现象”的假说，而血管紧张素 II 也可以通过非 ACE 途径生成的发现则进一步加强了这一假说。因此，血管紧张素受体阻滞剂（ARB）与 ACE 抑制剂联合使用可通过阻断血管紧张素 II 受体 1 型上的所有血管紧张素 II 以及允许血管紧张素 II 刺激未占据的血管紧张素 II 受体 2 型来产生额外的益处，从而引起额外的血管舒张和抗重构作用。然而，对包括高血压、心力衰竭和肾脏疾病在内的各种研究的分析表明，联合使用 ACE 抑制剂、ARB 或肾素阻滞剂阿利克仑时，获益并不显著。总之，基于该分析结果，在正在进行的研究提供更多信息之前，不应该将肾素-血管紧张素-醛固酮系统的双重阻断用于治疗高血压、心力衰竭和肾脏疾病，或许除了伴有蛋白尿的糖尿病肾病以外。
