Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA.
Kidney Int. 2011 Aug;80(3):245-55. doi: 10.1038/ki.2011.142. Epub 2011 Jun 1.
Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers are considered the standard of care for treatment of cardiovascular disease and chronic kidney disease. Combination therapy with both angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers effectively inhibits the renin-angiotensin system as well as potentiates the vasodilatory effects of bradykinin. It has been advocated that this dual blockade approach theoretically should result in improved clinical outcomes in both cardiovascular disease and chronic kidney disease. Clinical trial evidence for the use of combination therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in cardiovascular disease has provided conflicting results in hypertension, congestive heart failure, and ischemic heart disease. Clinical trial evidence to support combination therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in chronic kidney disease has largely been based on proteinuria reduction as a surrogate marker for clinically meaningful outcomes. Recent large-scale randomized clinical trials have not been able to validate protection in halting progression in chronic kidney disease with a dual blockade approach. This review serves as an appraisal on the clinical evidence of combination angiotensin-converting enzyme inhibition and angiotensin II receptor blockade in both cardiovascular disease and chronic kidney disease.
血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂被认为是治疗心血管疾病和慢性肾病的标准治疗方法。血管紧张素转换酶抑制剂和血管紧张素 II 受体阻滞剂联合治疗可有效抑制肾素-血管紧张素系统，并增强缓激肽的血管扩张作用。有人主张，这种双重阻断方法理论上应该在心血管疾病和慢性肾病中改善临床结局。在高血压、充血性心力衰竭和缺血性心脏病中，血管紧张素转换酶抑制剂和血管紧张素 II 受体阻滞剂联合治疗的临床试验证据提供了相互矛盾的结果。支持血管紧张素转换酶抑制剂和血管紧张素 II 受体阻滞剂联合治疗慢性肾病的临床试验证据主要基于蛋白尿减少作为临床有意义结局的替代标志物。最近的大规模随机临床试验未能证实双重阻断方法在阻止慢性肾病进展方面的保护作用。这篇综述评估了血管紧张素转换酶抑制和血管紧张素 II 受体阻断联合应用于心血管疾病和慢性肾病的临床证据。
