Volpe Massimo, Santolamazza Caterina, Tocci Giuliano
Cardiology Unit, Department of Clinical and Molecular Medicine, School of Medicine and Psychology, University Sapienza of Rome, S. Andrea Hospital, Rome, Italy.
IRCSS - Neuromed, Pozzilli, IS, Italy.
Curr Cardiol Rep. 2016 Dec;18(12):127. doi: 10.1007/s11886-016-0807-9.
Hypertension (HTN) is a well-known health problem associated with considerable morbidity and mortality and it is an important risk factor for the development of heart failure (HF). These findings support the need for optimizing the antihypertensive strategies to prevent the progression to HF. Interestingly, the progression from HTN to HF, among other things, may be a consequence of inappropriate over-activation of the renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), and the natriuretic peptide system (NPS). In the present review, we will discuss the pathophysiological aspects of the progression from HTN to HF with reduced ejection fraction (HFrEF) and we will focus on the evolution of different pharmacological therapies which are reported to be effective in reducing BP and improving HF outcomes, paying particular attention to the recent trials that have demonstrated the efficacy of the combined therapy of RAAS blockade and Neprilysin (NEP) inhibitor in lowering BP and mediating several beneficial actions within cardiovascular tissues, such as avoiding the worsening of HF.
高血压（HTN）是一个众所周知的健康问题，与相当高的发病率和死亡率相关，并且是心力衰竭（HF）发生的重要危险因素。这些发现支持了优化抗高血压策略以防止进展为HF的必要性。有趣的是，从HTN进展到HF，除其他因素外，可能是肾素-血管紧张素-醛固酮系统（RAAS）、交感神经系统（SNS）和利钠肽系统（NPS）不适当过度激活的结果。在本综述中，我们将讨论从HTN进展到射血分数降低的心力衰竭（HFrEF）的病理生理学方面，并且我们将关注据报道在降低血压和改善HF结局方面有效的不同药物治疗的进展，特别关注最近证明RAAS阻断和中性肽链内切酶（NEP）抑制剂联合治疗在降低血压和介导心血管组织内多种有益作用（如避免HF恶化）方面疗效的试验。
