Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189 Rome, Italy.
QJM. 2012 Jan;105(1):11-27. doi: 10.1093/qjmed/hcr190. Epub 2011 Oct 19.
Despite considerable advances in preventative treatment during the last two decades, the increasing burden of cardiovascular (CV) disease constitutes an urgent need for new therapeutic strategies to reduce CV mortality and morbidity in patients at high CV risk. Activation of the renin-angiotensin system (RAS) results in vasoconstrictive, proliferative and pro-inflammatory effects that contribute to the development of atherosclerosis. As a result, the RAS is implicated at all stages of the 'CV continuum' that links risk factors such as hypertension and dyslipidaemia with major CV events, congestive heart failure (CHF) and CV death. The RAS therefore represents a rational and ideal therapeutic target in CV risk reduction strategies. Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have been shown to promote beneficial effects on end-organ damage, such as decreases in arterial stiffness and left ventricular hypertrophy (LVH). Several trials have shown that ACE inhibitors and ARBs reduce CV risk in patients with specific risk factors. Furthermore, the HOPE study and, more recently, the ONTARGET® study have shown that ramipril and telmisartan reduce CV risk in patients with a high CV risk profile across the 'CV continuum'. Telmisartan is the first ARB to demonstrate CV prevention in patients at high CV risk, similar to that of the gold-standard ACE inhibitor, ramipril. This extensive clinical trial evidence suggests that ACE inhibitors or ARBs should be part of the standard treatment for patients at risk of CV events. ARBs may represent a preferred option due to their unsurpassed tolerability.
尽管在过去二十年中，预防治疗取得了相当大的进展，但心血管疾病负担的增加仍然迫切需要新的治疗策略，以降低高危心血管疾病患者的心血管死亡率和发病率。肾素-血管紧张素系统 (RAS) 的激活会导致血管收缩、增殖和炎症反应，从而促进动脉粥样硬化的发展。因此，RAS 与心血管风险因素（如高血压和血脂异常）与主要心血管事件、充血性心力衰竭 (CHF) 和心血管死亡相关的“心血管连续统”的所有阶段都有关联。因此，RAS 是降低心血管风险策略中合理且理想的治疗靶点。血管紧张素转换酶 (ACE) 抑制剂和血管紧张素 II 受体阻滞剂 (ARB) 已被证明可对终末器官损伤产生有益影响，例如降低动脉僵硬和左心室肥厚 (LVH)。多项试验表明，ACE 抑制剂和 ARB 可降低具有特定风险因素的患者的心血管风险。此外，HOPE 研究和最近的 ONTARGET®研究表明，雷米普利和替米沙坦可降低“心血管连续统”中具有高心血管风险特征的患者的心血管风险。替米沙坦是第一个在高心血管风险患者中证明具有心血管预防作用的 ARB，与金标准 ACE 抑制剂雷米普利相似。这些广泛的临床试验证据表明，ACE 抑制剂或 ARB 应成为心血管事件高危患者标准治疗的一部分。由于无与伦比的耐受性，ARB 可能是首选。
