Division of Nephrology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
Pediatr Nephrol. 2019 Sep;34(9):1521-1532. doi: 10.1007/s00467-018-4046-8. Epub 2018 Aug 15.
The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in a host of renal and cardiovascular functions. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), drugs that disrupt RAAS function, are effective in treating hypertension and offer other renoprotective effects independent of blood pressure (BP) reduction. As our understanding of RAAS physiology and the feedback mechanisms of ACE inhibition and angiotensin receptor blockade have improved, questions have been raised as to whether combination ACEI/ARB therapy is warranted in certain patients with incomplete angiotensin blockade on one agent. In this review, we discuss the rationale for combination ACEI/ARB therapy and summarize the results of key adult studies and the limited pediatric literature that have investigated this therapeutic approach. We additionally review novel therapies that have been developed over the past decade as alternative approaches to combination ACEI/ARB therapy, or that may be potentially used in combination with ACEIs or ARBs, in which further adult and pediatric studies are needed.
肾素-血管紧张素-醛固酮系统（RAAS）在许多肾脏和心血管功能中起着关键作用。血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）是干扰 RAAS 功能的药物，它们在治疗高血压方面有效，并提供独立于血压（BP）降低的其他肾脏保护作用。随着我们对 RAAS 生理学和 ACE 抑制和血管紧张素受体阻断的反馈机制的理解的提高，人们提出了这样一个问题，即在一种药物上不完全阻断血管紧张素的情况下，是否有必要对某些患者进行 ACEI/ARB 联合治疗。在这篇综述中，我们讨论了联合 ACEI/ARB 治疗的基本原理，并总结了关键的成人研究结果和有限的儿科文献，这些研究调查了这种治疗方法。我们还回顾了过去十年中开发的新疗法，这些疗法是 ACEI/ARB 联合治疗的替代方法，或者可能与 ACEI 或 ARB 联合使用，需要进一步开展成人和儿科研究。
