Division of Cardiology, Department of Clinical and Molecular Medicine, niversity of Rome "Sapienza", Sant'Andrea Hospital, Rome, and IRCCS Neuromed, Pozzilli, Italy.
Drugs. 2011 May 28;71(8):1003-17. doi: 10.2165/11591350-000000000-00000.
The renin-angiotensin system (RAS) plays a key role in a number of pathophysiological mechanisms that are involved in the development and progression of cardiovascular and renal disease. For these reasons, pharmacological antagonism of this system, particularly the blockade of formation or the receptor antagonism of angiotensin II, has been demonstrated to be an effective and safe strategy to reduce the burden of cardiovascular disease. Among different drug classes, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) have provided an excellent alternative to ACE inhibitors, representing a more selective and a better tolerated pharmacological approach to interfere with the RAS. Results derived from large, international, randomized clinical trials have consistently indicated that ARB-based therapeutic strategies may effectively provide cardiovascular and renal disease prevention and protection in different clinical conditions across the entire cardiovascular continuum. This article reviews the pathophysiological rationale of RAS involvement in the pathogenesis of renal diseases, focusing on the beneficial effects provided by ARBs in terms of renal protection.
肾素-血管紧张素系统（RAS）在许多参与心血管和肾脏疾病发展和进展的病理生理机制中发挥着关键作用。出于这些原因，该系统的药理学拮抗作用，特别是血管紧张素 II 的形成或受体拮抗作用，已被证明是降低心血管疾病负担的有效且安全的策略。在不同的药物类别中，血管紧张素 II 型 1 受体拮抗剂（血管紧张素受体阻滞剂 [ARB]）为 ACE 抑制剂提供了极好的替代品，代表了一种更具选择性和更好耐受性的药理学方法来干扰 RAS。来自大型国际随机临床试验的结果一致表明，基于 ARB 的治疗策略可能在整个心血管连续体的不同临床情况下有效地提供心血管和肾脏疾病的预防和保护。本文回顾了 RAS 在肾脏疾病发病机制中的病理生理学基础，重点介绍了 ARB 在肾脏保护方面提供的有益作用。
