Lambers Heerspink H J
Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Contrib Nephrol. 2013;179:7-14. doi: 10.1159/000346717. Epub 2013 May 3.
Blood pressure is a strong risk factor for ischemic and atherosclerotic events such as stroke. Blood pressure is often elevated in patients with chronic kidney disease. Consequently, chronic kidney disease patients are at high risk of developing cardiovascular and cerebrovascular damage. Blood pressure reduction by means of inhibiting the renin-angiotensin-aldosterone system (RAAS) reduces the risk of stroke. There is evidence available in the primary and secondary prevention of stroke that RAAS blockade exerts cerebrovascular protective effects independent of blood pressure lowering. This chapter discusses the role of RAAS blockade for the prevention and treatment of stroke in chronic kidney disease. The role of dual RAAS blockade will be reviewed and alternative strategies to enhance the effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers will be provided.
血压是缺血性和动脉粥样硬化性事件（如中风）的一个重要危险因素。慢性肾病患者的血压常常升高。因此，慢性肾病患者发生心血管和脑血管损害的风险很高。通过抑制肾素-血管紧张素-醛固酮系统（RAAS）来降低血压可降低中风风险。在中风的一级和二级预防中有证据表明，RAAS阻断具有独立于降压作用之外的脑血管保护作用。本章讨论RAAS阻断在慢性肾病中风预防和治疗中的作用。将对双重RAAS阻断的作用进行综述，并提供增强血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂效果的替代策略。
