Mount Sinai St. Luke's & Mount Sinai West Hospitals, New York, NY.
New York University School of Medicine, New York, NY.
Prog Cardiovasc Dis. 2016 Nov-Dec;59(3):253-261. doi: 10.1016/j.pcad.2016.10.002. Epub 2016 Oct 21.
The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in the pathogenesis of hypertension (HTN). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are first line anti-HTN drug classes that are potent, effective and largely safe. Direct renin inhibitors (DRIs) have shown similar blood pressure (BP) reduction but more side effects. The efficacy of ACEIs and ARBs (for cardiovascular, cerebrovascular and renal protection) has been promoted to extend beyond what could be explained by BP reduction alone. In the current review, we will briefly discuss the (1) pathophysiology of renin-angiotensin-aldosterone system (RAAS) system, (2) clinical evidence for ACEIs, ARBs and DRIs in HTN, (3) comparison of ACEIs vs. ARBs and combination therapy, (4) role of RAAS inhibitors in specific patient populations, (5) safety profile of RAAS inhibitors, and (6) guideline recommendations and future perspectives. Closer scrutiny of outcome data shows little, if any, evidence that the efficacy of RAAS blockers in HTN extends beyond BP reduction.
肾素-血管紧张素-醛固酮系统（RAAS）在高血压（HTN）的发病机制中起着关键作用。血管紧张素转换酶抑制剂（ACEIs）和血管紧张素 II 受体阻滞剂（ARBs）是一线抗高血压药物，具有强大、有效且基本安全的特点。直接肾素抑制剂（DRIs）已显示出类似的血压（BP）降低作用，但副作用更多。ACEIs 和 ARBs（用于心血管、脑血管和肾脏保护）的疗效已被推广到超出仅通过降低血压所能解释的范围。在本次综述中，我们将简要讨论（1）肾素-血管紧张素-醛固酮系统（RAAS）的病理生理学，（2）ACEIs、ARBs 和 DRIs 在 HTN 中的临床证据，（3）ACEIs 与 ARBs 及联合治疗的比较，（4）RAAS 抑制剂在特定患者人群中的作用，（5）RAAS 抑制剂的安全性概况，以及（6）指南建议和未来展望。对结果数据的更仔细审查表明，RAAS 阻滞剂在 HTN 中的疗效是否超出降低血压几乎没有证据。
