Tran Henry A, Schwartzbard Arthur, Weintraub Howard S
Division of Cardiology, Department of Medicine, NYU Langone Medical Center, Tisch Hospital, 530 First Avenue, Suite 9U, New York, NY, 10016, USA.
Curr Treat Options Cardiovasc Med. 2011 Aug;13(4):279-88. doi: 10.1007/s11936-011-0126-9.
The pathogenesis of cardiovascular disease is a complex and dynamic process. The renin-angiotensin-aldosterone system (RAAS) is a potent and powerful mediator in the homeostasis of the cardiovascular and renal systems. RAAS blockade via angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has been consistently proven to be an effective and safe strategy for the primary and secondary prevention of cardiovascular disease in patients across a wide spectrum of risk. Although the beneficial effects of RAAS blockade may be due to its effects on central and peripheral blood pressure, there are many additional mechanisms to consider that may contribute additional protection. While a combination of ACE inhibitors and ARBs has not yielded significantly positive results, the newer class of direct renin inhibitors (DRIs) may offer a novel and effective strategy for monotherapy as well as in combination.
心血管疾病的发病机制是一个复杂且动态的过程。肾素-血管紧张素-醛固酮系统（RAAS）是心血管和肾脏系统稳态中一种强大且有力的介质。通过血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）阻断RAAS，已被持续证明是在广泛风险范围内的患者中进行心血管疾病一级和二级预防的有效且安全的策略。尽管RAAS阻断的有益作用可能归因于其对中心和外周血压的影响，但还有许多其他机制值得考虑，这些机制可能提供额外的保护作用。虽然ACE抑制剂和ARB联合使用尚未产生显著的阳性结果，但新型的直接肾素抑制剂（DRI）可能为单一疗法以及联合疗法提供一种新颖且有效的策略。
