Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS 39216, USA.
Am J Med. 2011 Jan;124(1):15-9. doi: 10.1016/j.amjmed.2010.07.021.
Our understanding of the complexities and inter-related pathways of the renin-angiotensin-aldosterone system continues to evolve. Which drugs to use, when, and how, are everyday questions faced by clinicians in the ambulatory setting. Combining these classes, for the purpose of enhancing renin-angiotensin-aldosterone system blockade and incremental blood pressure, nephroprotective, and cardioprotective effects, logically has emerged as an area for scientific inquiry and clinical use. Despite the lack of evidence on safety and efficacy in most disease states, dual therapy has been embraced as a treatment option. Most studies of angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) combination therapy in the treatment of hypertension have limitations. In contrast, combination ACE inhibitor-ARB therapy in systolic heart failure has been addressed in several large randomized controlled trials. Until recently, there has been limited and conflicting evidence for the use of combination therapy for the prevention or management of nephropathy. Based on the new evidence, combination ACE inhibitor-ARB therapy in the treatment and management of hypertension, heart failure, and nephropathy should be limited.
我们对肾素-血管紧张素-醛固酮系统的复杂性和相互关联的途径的理解仍在不断发展。在门诊环境中，临床医生每天都面临着使用哪些药物、何时使用以及如何使用的问题。出于增强肾素-血管紧张素-醛固酮系统阻断作用以及增加血压、肾脏保护和心脏保护效果的目的，联合使用这些类别药物已成为科学研究和临床应用的一个领域。尽管在大多数疾病状态下缺乏安全性和疗效的证据，但双重治疗已被作为一种治疗选择。在高血压的治疗中，大多数关于血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）联合治疗的研究都存在局限性。相比之下，在射血分数降低的心力衰竭中，已经有几项大型随机对照试验研究了 ACE 抑制剂-ARB 联合治疗。直到最近，联合治疗在预防或治疗肾病方面的证据还很有限且相互矛盾。基于新的证据，在治疗和管理高血压、心力衰竭和肾病方面，应限制使用 ACE 抑制剂-ARB 联合治疗。
