肾素-血管紧张素-醛固酮系统的完全抑制；我们目前的情况如何？
Complete inhibition of the renin-angiotensin-aldosterone system; where do we stand?
作者信息
Chen Shan Shan, Seliger Stephen L, Fried Linda F
机构信息
aUniversity of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania bVA Maryland Healthcare System and University of Maryland School of Medicine, Baltimore, Maryland cVA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
出版信息
Curr Opin Nephrol Hypertens. 2014 Sep;23(5):449-55. doi: 10.1097/MNH.0000000000000043.
PURPOSE OF REVIEW
This review presents the role of combination therapy of renin-angiotensin-aldosterone system blockade on cardiovascular and kidney disease.
RECENT FINDINGS
Three large randomized controlled trials comparing combination therapy of renin-angiotensin-aldosterone system blockade to monotherapy in individuals with increased cardiovascular risk, chronic kidney disease, or diabetic nephropathy have been reported. These trials - ONTARGET, ALTITUDE, and VA NEPHRON-D - demonstrated an excess risk of adverse effects [especially acute kidney injury (AKI) and hyperkalemia] with combination therapy, without significant benefit in reducing cardiovascular and renal morbidity.
SUMMARY
Current evidence supports avoiding dual renin-angiotensin-aldosterone system blockade in patients with chronic kidney disease. Subsequent studies of dual renin-angiotensin-aldosterone system blockade should examine adverse event risks and renal progression endpoints.
综述目的
本综述阐述了肾素-血管紧张素-醛固酮系统阻断联合治疗在心血管疾病和肾脏疾病中的作用。
最新发现
已有三项大型随机对照试验报告，比较了肾素-血管紧张素-醛固酮系统阻断联合治疗与单一疗法在心血管风险增加、慢性肾病或糖尿病肾病患者中的疗效。这些试验——ONTARGET、ALTITUDE和VA NEPHRON-D——表明联合治疗存在不良反应风险增加（尤其是急性肾损伤和高钾血症），在降低心血管和肾脏发病率方面无显著益处。
总结
目前的证据支持避免在慢性肾病患者中进行双重肾素-血管紧张素-醛固酮系统阻断。后续关于双重肾素-血管紧张素-醛固酮系统阻断的研究应考察不良事件风险和肾脏进展终点。
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