Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension Unit, University of Turin, Italy.
Curr Pharm Des. 2012;18(7):952-7. doi: 10.2174/138161212799436566.
The renin angiotensin aldosterone system (RAAS) inhibitors induce an incomplete blockade of the system at different steps. Recently, the dual RAAS therapy is emerging in clinical practice, although there is a lack of evidence on safety and efficacy for this combination in several cardiovascular diseases. In this review, we evaluated the advantages and disadvantages of dual RAAS blockade in hypertension, proteinuric renal disease, heart failure and ischaemic heart disease. The role of DRIs in combination with ACEI or ARBs is promising, but still needs further studies. On the basis of the clinical outcomes and safety data the recommendations guidelines have not confirmed indications to dual RAAS blockade in essential hypertension treatment, heart failure and ischemic heart disease. Only proteinuric nephropathies and resistant hypertension may represent possible indications to dual RAAS blockade. Actually, rational combinations of either an ACEI or ARB or DRI with other classes of antihypertensives offer best solutions.
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂在不同步骤诱导系统不完全阻断。最近，双重 RAAS 治疗在临床实践中出现，尽管在几种心血管疾病中，这种联合的安全性和疗效缺乏证据。在这篇综述中，我们评估了双重 RAAS 阻断在高血压、蛋白尿性肾病、心力衰竭和缺血性心脏病中的优缺点。DRIs 与 ACEI 或 ARB 的联合具有很大的应用前景，但仍需要进一步的研究。基于临床结果和安全性数据，推荐指南并未在原发性高血压治疗、心力衰竭和缺血性心脏病中证实双重 RAAS 阻断的适应证。只有蛋白尿性肾病和难治性高血压可能是双重 RAAS 阻断的可能适应证。实际上，ACEI 或 ARB 或 DRI 与其他降压药物的合理联合提供了最佳的解决方案。
