Center for Heart Transplant and Assist Devices, Advocate Christ Medical Center, 4400 West 95th Street, Suite 407, Oak Lawn, IL 60453, USA; University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA.
Cardiol Clin. 2014 Feb;32(1):21-32, vii. doi: 10.1016/j.ccl.2013.09.002.
The renin-angiotensin-aldosterone system (RAAS) plays a critical role in the pathophysiology of heart failure with reduced ejection fraction (HFrEF). Targeting components of the RAAS has produced significant improvements in morbidity and mortality. Angiotensin-converting enzyme (ACE) inhibitors remain first-line therapy for all patients with a reduced ejection fraction. Angiotensin-receptor blockers may be used instead of ACE inhibitors in patients with intolerance, or in conjunction with ACE inhibitors to further reduce symptoms. Recent data support broader indications for aldosterone antagonists in heart failure, and the combination of an ACE-inhibitor and aldosterone antagonist has become the preferred strategy for dual blockade of the RAAS.
肾素-血管紧张素-醛固酮系统（RAAS）在射血分数降低的心力衰竭（HFrEF）的病理生理学中起着关键作用。针对 RAAS 的成分进行靶向治疗已显著改善了发病率和死亡率。血管紧张素转换酶（ACE）抑制剂仍然是所有射血分数降低的患者的一线治疗药物。对于不耐受的患者，可以使用血管紧张素受体阻滞剂代替 ACE 抑制剂，或者与 ACE 抑制剂联合使用以进一步减轻症状。最近的数据支持在心力衰竭中更广泛地使用醛固酮拮抗剂，并将 ACE 抑制剂和醛固酮拮抗剂联合使用作为双重阻断 RAAS 的首选策略。
