Messerli Franz H, Chiadika Simbo M
St Luke's-Roosevelt Hospital, New York, US,
St Luke's-Roosevelt Hospital, New York, US.
J Renin Angiotensin Aldosterone Syst. 2005 Mar;6(1_suppl):S4-S7. doi: 10.1177/14703203050060010201.
Reductions in blood pressure (BP) through intervention can significantly reduce the risk of cardiovascular events in hypertensive patients. However, a number of trials indicate that beta-blockers, despite lowering BP, do not reduce the risk of stroke. A recent meta-analysis suggested that, over and beyond BP reduction, angiotensin-converting enzyme (ACE) inhibitors appear superior to calcium channel blockers for prevention of coronary heart disease whereas calcium channel blockers appear superior to ACE inhibitors for prevention of stroke. Indeed, in the Syst-EUR study a 42% reduction in strokes was achieved in the calcium antagonist arm when compared to the placebo arm.It is hypothesised that antihypertensive agents that stimulate the AT2-receptor (thiazide diuretics, dihydropyridine calcium antagonists and angiotensin receptor blockers) are more cerebroprotective than drug classes that do not stimulate the AT2-receptor (beta-blockers and ACE inhibitors).The angiotensin receptor blockers are the only drug class that have a dual mechanism of action that could be helpful in preventing strokes in that they not only inhibit the AT1-receptor but also allow stimulation of the AT2-receptor. Not surprisingly therefore, in trials such as LIFE, VALUE and MOSES, angiotensin receptor blockers showed excellent cerebroprotection.
通过干预降低血压（BP）可显著降低高血压患者发生心血管事件的风险。然而，多项试验表明，β受体阻滞剂尽管能降低血压，但并不能降低中风风险。最近的一项荟萃分析表明，除了降低血压外，血管紧张素转换酶（ACE）抑制剂在预防冠心病方面似乎优于钙通道阻滞剂，而钙通道阻滞剂在预防中风方面似乎优于ACE抑制剂。事实上，在Syst-EUR研究中，与安慰剂组相比，钙拮抗剂组的中风发生率降低了42%。据推测，刺激AT2受体的抗高血压药物（噻嗪类利尿剂、二氢吡啶类钙拮抗剂和血管紧张素受体阻滞剂）比不刺激AT2受体的药物类别（β受体阻滞剂和ACE抑制剂）更具脑保护作用。血管紧张素受体阻滞剂是唯一具有双重作用机制的药物类别，这可能有助于预防中风，因为它们不仅抑制AT1受体，还能刺激AT2受体。因此，毫不奇怪，在LIFE、VALUE和MOSES等试验中，血管紧张素受体阻滞剂显示出优异的脑保护作用。
