Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Biomed Res Int. 2018 Oct 2;2018:7902081. doi: 10.1155/2018/7902081. eCollection 2018.
Coronary artery disease (CAD) and stroke are the most common and serious long-term complications of hypertension. Acetylsalicylic acid (ASA) significantly reduces their incidence and cardiovascular mortality. The RAAS activation plays an important role in pathogenesis of CVD, resulting in increased vascular resistance, proliferation of vascular-smooth-muscle-cells, and cardiac hypertrophy. Drugs acting on the renin-angiotensin-aldosterone system (RAAS) are demonstrated to reduce cardiovascular events in population with cardiovascular disease (CVD). The cyclooxygenase inhibitors limit the beneficial effect of RAAS-inhibitors, which in turn may be important in subjects with hypertension, CAD, and congestive heart failure. These observations apply to most of nonsteroidal anti-inflammatory drugs and ASA at high doses. Nevertheless, there is no strong evidence confirming presence of similar effects of cardioprotective ASA doses. The benefit of combined therapy with low-doses of ASA is-in some cases-significantly higher than that of monotherapy. So far, the significance of ASA in optimizing the pharmacotherapy remains not fully established. A better understanding of its influence on the particular CVD should contribute to more precise identification of patients in whom benefits of ASA outweigh the complication risk. This brief review summarizes the data regarding usefulness and safety of the ASA combination with drugs acting directly on the RAAS.
冠心病和中风是高血压最常见和最严重的长期并发症。乙酰水杨酸（ASA）能显著降低其发病率和心血管死亡率。肾素-血管紧张素-醛固酮系统（RAAS）的激活在心血管疾病（CVD）的发病机制中起重要作用，导致血管阻力增加、血管平滑肌细胞增殖和心脏肥大。作用于 RAAS 的药物已被证明可减少 CVD 患者的心血管事件。环氧化酶抑制剂限制了 RAAS 抑制剂的有益作用，这在高血压、冠心病和充血性心力衰竭患者中可能很重要。这些观察结果适用于大多数非甾体抗炎药和高剂量的 ASA。然而，目前尚无强有力的证据证实低剂量 ASA 具有类似的心脏保护作用。联合应用小剂量 ASA 的治疗益处——在某些情况下——明显高于单药治疗。到目前为止，ASA 在优化药物治疗中的意义尚未完全确定。更好地了解其对特定 CVD 的影响有助于更准确地确定 ASA 获益超过并发症风险的患者。这篇简短的综述总结了关于 ASA 与直接作用于 RAAS 的药物联合应用的疗效和安全性的数据。
