Abdellatif Abdul Ali
Kidney Hypertension Transplant Clinic, Clear Lake Specialties, Baylor College of Medicine, Houston, TX 77030, USA.
Expert Rev Cardiovasc Ther. 2012 Feb;10(2):251-63. doi: 10.1586/erc.11.186.
Comorbid hypertension and diabetes is common and associated with substantially greater cardiovascular and renal risk relative to hypertension alone. Tissue renin-angiotensin system (RAS) overactivity is a hallmark of diabetes and contributes to target organ damage. Treatment guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for reducing cardiorenal risk in patients with hypertension plus diabetes. However, these agents only partially prevent cardiovascular and renal morbidity/mortality. Further attempts to improve clinical outcomes have focused on the use of an ACE inhibitor plus an ARB, but this combination has not demonstrated a favorable risk-benefit profile. Direct renin inhibitors provide a more comprehensive blockade of the RAS compared with ACE inhibitors or ARBs, and may be of particular benefit in counteracting tissue RAS overactivity. In this article, the role of the RAS in diabetic hypertension and the preclinical and clinical effects of direct renin inhibitor therapy on target organs are reviewed.
高血压合并糖尿病很常见，与仅患高血压相比，其心血管和肾脏风险显著更高。组织肾素-血管紧张素系统（RAS）过度活跃是糖尿病的一个标志，并导致靶器官损害。治疗指南推荐使用血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）来降低高血压合并糖尿病患者的心肾风险。然而，这些药物只能部分预防心血管和肾脏疾病的发生/死亡。进一步改善临床结局的尝试集中在联合使用ACE抑制剂和ARB，但这种联合用药尚未显示出良好的风险效益比。与ACE抑制剂或ARB相比，直接肾素抑制剂能更全面地阻断RAS，在对抗组织RAS过度活跃方面可能具有特殊益处。本文综述了RAS在糖尿病性高血压中的作用以及直接肾素抑制剂治疗对靶器官的临床前和临床效果。
