Chrysant Steven G, Chrysant George S
College of Medicine, University of Oklahoma, 5700 Mistletoe Court, Oklahoma City, OK, 73142, USA,
Curr Hypertens Rep. 2015 Jan;17(1):511. doi: 10.1007/s11906-014-0511-3.
Single renin-angiotensin-aldosterone system (RAAS) blockade has been shown to be effective and safe for the treatment of hypertension, coronary heart disease (CHD), heart failure (HF), diabetes, and chronic kidney disease (CKD) with proteinuria. Due to the action of RAAS blockers at various levels of the RAAS cascade, it was hypothesized that dual RAAS blockade would result in more complete inhibition of angiotensin II (Ang II) production and be more effective in blocking its detrimental cardiovascular remodeling effects. Unfortunately, several clinical trials in patients with hypertension, CHD, HF, and CKD with proteinuria have demonstrated no superiority of dual versus single RAAS blockade, but a higher incidence of adverse events. Based on these findings, dual RAAS blockade is no longer recommended for the routine treatment of various cardiovascular diseases, except diabetic nephropathy with proteinuria and HF with reduced ejection fraction. All the new information gathered from studies within the last 3 years will be presented in this review.
单肾素-血管紧张素-醛固酮系统（RAAS）阻断已被证明对治疗高血压、冠心病（CHD）、心力衰竭（HF）、糖尿病以及伴有蛋白尿的慢性肾脏病（CKD）有效且安全。由于RAAS阻滞剂在RAAS级联反应的不同水平发挥作用，因此有人推测双重RAAS阻断会更完全地抑制血管紧张素II（Ang II）的产生，并在阻断其有害的心血管重塑作用方面更有效。不幸的是，多项针对高血压、CHD、HF以及伴有蛋白尿的CKD患者的临床试验表明，双重RAAS阻断并不优于单重RAAS阻断，反而不良事件发生率更高。基于这些发现，除了伴有蛋白尿的糖尿病肾病和射血分数降低的HF外，不再推荐双重RAAS阻断用于各种心血管疾病的常规治疗。本综述将呈现过去3年内研究获得的所有新信息。
