Abraham Hazel Mae A, White C Michael, White William B
Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut Health Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06032, USA.
Drug Saf. 2015 Jan;38(1):33-54. doi: 10.1007/s40264-014-0239-7.
All national guidelines for the management of hypertension recommend angiotensin receptor blockers (ARBs) as an initial or add-on antihypertensive therapy. The eight available ARBs have variable clinical efficacy when used for control of hypertension. Additive blood pressure-lowering effects have been demonstrated when ARBs are combined with thiazide diuretics or dihydropyridine calcium channel blockers, augmenting hypertension control. Furthermore, therapeutic use of ARBs goes beyond their antihypertensive effects, with evidence-based benefits in heart failure and diabetic renal disease particularly among angiotensin-converting enzyme inhibitor-intolerant patients. On the other hand, combining renin-angiotensin system blocking agents, a formerly common practice among medical subspecialists focusing on the management of hypertension, has ceased, as there is not only no evidence of cardiovascular benefit but also modest evidence of harm, particularly with regard to renal dysfunction. ARBs are very well tolerated as monotherapy, as well as in combination with other antihypertensive medications, which improve adherence to therapy and have become a mainstay in the treatment of stage 1 and stage 2 hypertension.
所有高血压管理的国家指南都推荐血管紧张素受体阻滞剂（ARB）作为初始或附加的抗高血压治疗药物。目前可用的8种ARB在用于控制高血压时具有不同的临床疗效。当ARB与噻嗪类利尿剂或二氢吡啶类钙通道阻滞剂联合使用时，已证明具有额外的降压作用，可增强高血压控制效果。此外，ARB的治疗用途不仅限于其降压作用，在心力衰竭和糖尿病肾病中具有循证益处，尤其是在不能耐受血管紧张素转换酶抑制剂的患者中。另一方面，联合使用肾素-血管紧张素系统阻滞剂，这一过去专注于高血压管理的医学亚专科医生中常见的做法，现已停止，因为不仅没有心血管益处的证据，而且有适度的危害证据，特别是在肾功能障碍方面。ARB作为单一疗法以及与其他抗高血压药物联合使用时耐受性良好，这提高了治疗依从性，并已成为1期和2期高血压治疗的主要手段。
