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肾素-血管紧张素-醛固酮系统的抑制作用:聚焦于阿利吉仑。

Inhibition of the renin angiotensin aldosterone system: focus on aliskiren.

作者信息

Rao Maddury Srinivasa

机构信息

Care Hospital, Road No. 1, Banjara Hills, Hyderabad.

出版信息

J Assoc Physicians India. 2010 Feb;58:102-8.

Abstract

The renin-angiotensin system (RAS) or the renin-angiotensin-aldosterone system (RAAS) is a major endocrine/paracrine system that regulates blood pressure (BP) via angiotensin release and fluid and electrolyte homoeostasis via aldosterone release. RAAS should be constantly suppressed and any degree of activity may lead to hypertension (HTN) and associated target organ damage. Activation of the RAAS in the pathogenesis of HTN, CVD and renal disease is well documented. Also benefits of inhibition of RAAS, as an effective way to intervene in pathogenesis HTN, CVD and CRF, has been well recognized. RAAS may be blocked by drugs at various points and is important target site for five distinctive classes of hypertensive drugs; beta blockers, renin inhibitors, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and aldosterone inhibitors. Inhibition of renin activity and the blocked of RAAS cascade at its primary steps, has long been proposed as the optimal means of RAAS Inhibition. Renin inhibitor provides more effective means of RAAS Inhibition. Aliskiren is the first in a new class of orally active, non-peptide, low molecular weight direct renin inhibitor (DRI) available for clinical use and potential new approach to the blockade of the RAAS. An average plasma half-life of 23.7 hours (range 20-45 hours), makes drug suitable for once daily administration. BP-lowering affect of aliskiren is associated with a decreased, not increased, generation of Ang I, as it blocks generation of Ang I from angiotensinogen, by inhibiting the active enzymatic site of renin. Aliskiren has generally been well tolerated with adverse events and discontinuation rates similar to placebo in most clinical trials. Aliskiren has the potential to be useful in this wide spectrum of conditions and may provide organ protection independent of BP reductions.

摘要

肾素-血管紧张素系统(RAS)或肾素-血管紧张素-醛固酮系统(RAAS)是一个主要的内分泌/旁分泌系统,它通过释放血管紧张素调节血压(BP),并通过释放醛固酮调节体液和电解质平衡。RAAS应持续受到抑制,任何程度的活性增加都可能导致高血压(HTN)及相关靶器官损害。RAAS在HTN、心血管疾病(CVD)和肾脏疾病发病机制中的激活已有充分记录。此外,抑制RAAS作为干预HTN、CVD和慢性肾衰竭(CRF)发病机制的有效方法,其益处也已得到充分认识。RAAS可在多个环节被药物阻断,是五类不同的抗高血压药物的重要靶点;β受体阻滞剂、肾素抑制剂、血管紧张素转换酶(ACE)抑制剂、血管紧张素受体阻滞剂(ARB)和醛固酮抑制剂。长期以来,人们一直认为抑制肾素活性并在RAAS级联反应的起始步骤阻断它,是抑制RAAS的最佳方法。肾素抑制剂提供了更有效的RAAS抑制手段。阿利吉仑是一类新型口服活性、非肽、低分子量直接肾素抑制剂(DRI)中的首个药物,可用于临床,是阻断RAAS的一种潜在新方法。其平均血浆半衰期为23.7小时(范围为20 - 45小时),使得该药物适合每日一次给药。阿利吉仑的降压作用与血管紧张素I生成减少而非增加有关,因为它通过抑制肾素的活性酶位点,阻断了血管紧张素原生成血管紧张素I。在大多数临床试验中,阿利吉仑总体耐受性良好,不良事件和停药率与安慰剂相似。阿利吉仑在这类广泛的病症中具有潜在的应用价值,并且可能独立于血压降低提供器官保护作用。

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