Division of Cardiology, Department of Medicine, Albany Medical College, Albany, NY, USA.
Nephrology Section, Stratton VA Medical Center, 113 Holland Ave, Albany, NY, 12208, USA.
Curr Hypertens Rep. 2017 May;19(5):40. doi: 10.1007/s11906-017-0737-y.
The purpose of this study was to summarize recent findings about cardiovascular benefits and safety of aldosterone blockade in patients with end-stage renal disease (ESRD).
It is now well recognized that aldosterone's deleterious cardiovascular impact is not limited to its pressor effect arising from an increase in sodium reabsorption in the kidneys. Aldosterone has also been shown to increase blood pressure by a direct activation of the sympathetic nervous system, to cause endothelial and vascular smooth muscle cell dysfunction, myocardial remodeling and fibrosis, and to have pro-arrhythmogenic actions in the heart. These unconventional extra-renal effects of aldosterone make its blockade feasible and potentially beneficial for patients with ESRD. Accumulating data support the idea that aldosterone antagonism leads to a better blood pressure control, reduction in left ventricular (LV) mass, improved LV function, and reduced all-cause and cardiovascular mortality in ESRD patients. Reassuringly, rates of major adverse events, especially, significant hyperkalemia-the most feared adverse consequence-were low with careful patient selection and monitoring.
本研究旨在总结醛固酮阻断在终末期肾病（ESRD）患者中的心血管获益和安全性的最新发现。
目前人们已经充分认识到，醛固酮的有害心血管影响不仅限于其通过增加肾脏对钠的重吸收而产生的升压作用。醛固酮还通过直接激活交感神经系统、导致内皮和血管平滑肌细胞功能障碍、心肌重构和纤维化，以及在心脏中产生致心律失常作用，从而导致血压升高。醛固酮的这些非传统的肾脏外作用使其阻断成为可能，并可能对 ESRD 患者有益。越来越多的数据支持这样一种观点，即醛固酮拮抗作用可实现更好的血压控制、左心室（LV）质量减轻、LV 功能改善以及 ESRD 患者全因和心血管死亡率降低。令人放心的是，在仔细的患者选择和监测下，主要不良事件的发生率，特别是最令人担忧的不良后果——严重高钾血症的发生率较低。
