Robles Nicolás Roberto, Cerezo Isis, Hernandez-Gallego Roman
1Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain.
J Cardiovasc Pharmacol Ther. 2014 Jan;19(1):14-33. doi: 10.1177/1074248413501018. Epub 2013 Sep 13.
The two major classes of drugs that target the RAS are the angiotensin-converting enzyme (ACE) inhibitors and the selective AT1 receptor blockers (ARBs). Although both of these drug classes target angiotensin II, the differences in their mechanisms of action have implications for their effects on other pathways and receptors that may have therapeutic implications. Both ACEIs and ARBs are effective antihypertensive agents that have been shown to reduce the risk of cardiovascular and renal events. Direct inhibition of renin -the most proximal aspect of the RAS -became clinically feasible from 2007 with the introduction of aliskiren. This latter drug has been shown to be efficacious for the management of hypertension. Combined therapy of direct renin-inhibitors with ACEIs or ARBs has been tested in some clinical situations as congestive HF and proteinuria with diverse results. This article tries to offer an updated review of current knowledge on the use of RAS blocking drugs in clinical settings.
作用于肾素-血管紧张素系统（RAS）的两大类药物是血管紧张素转换酶（ACE）抑制剂和选择性AT1受体阻滞剂（ARB）。尽管这两类药物都作用于血管紧张素II，但其作用机制的差异对它们作用于其他可能具有治疗意义的途径和受体的效果有影响。ACEI和ARB都是有效的抗高血压药物，已被证明可降低心血管和肾脏事件的风险。自2007年阿利吉仑问世以来，直接抑制肾素（RAS最上游环节）在临床上变得可行。后一种药物已被证明对高血压治疗有效。直接肾素抑制剂与ACEI或ARB的联合治疗已在一些临床情况如充血性心力衰竭和蛋白尿中进行了试验，结果各异。本文试图对RAS阻断药物在临床应用中的现有知识进行更新综述。
