Dahlöf B
Department of Medicine, University of Göteborg, Ostra Hospital, Sweden.
J Hypertens Suppl. 1993 Apr;11(3):S29-35.
The renin-angiotensin system has an important effect on the development of cardiac hypertrophy and the regulation of left ventricular function, in particular by promoting cardiac interstitial fibrosis.
EFFECT OF ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS: In both experimental and human studies, ACE inhibitors have shown a clear tendency to perform better than other types of antihypertensive therapy in reversing cardiac structural changes. A recent meta-analysis of 109 studies showed that ACE inhibitors were more effective than beta-blockers, calcium antagonists and diuretics in reducing left ventricular mass. Furthermore, cardiac hypertrophy was reversed to a significantly greater extent with enalapril than hydrochlorothiazide in a long-term study of previously untreated men. Multivariate analyses of the results from that study showed that the reversal of cardiac hypertrophy was independently related to the blockade of the circulating renin-angiotensin system. Furthermore, experimental studies have shown that ACE inhibition can induce reversal of left ventricular hypertrophy even without a fall in blood pressure.
The novel angiotensin II blocker losartan has, like ACE inhibitors, shown significant effects on cardiovascular structure in animal models.
Blockade of the renin-angiotensin system with ACE inhibitors seems to have independent significance for the reversal of cardiac hypertrophy. However, we still do not know whether it is the attenuation of angiotensin II (locally or systemically), apart from a fall in blood pressure, that is the most important effect of ACE inhibition. Therefore, results from future studies on the ability of angiotensin II antagonists to affect left ventricular hypertrophy, in comparison with ACE inhibitors, are awaited with great interest, especially regarding the differential effects on myocyte hypertrophy and interstitial fibrosis.
肾素-血管紧张素系统对心脏肥大的发展及左心室功能的调节具有重要作用，尤其是通过促进心脏间质纤维化来实现。
血管紧张素转换酶（ACE）抑制剂的作用：在实验研究和人体研究中，ACE抑制剂在逆转心脏结构改变方面均表现出明显优于其他类型抗高血压治疗的倾向。最近一项对109项研究的荟萃分析表明，ACE抑制剂在减轻左心室质量方面比β受体阻滞剂、钙拮抗剂和利尿剂更有效。此外，在一项针对既往未接受治疗男性的长期研究中，依那普利使心脏肥大逆转的程度明显大于氢氯噻嗪。对该研究结果进行的多变量分析表明，心脏肥大的逆转与循环肾素-血管紧张素系统的阻断独立相关。此外，实验研究表明，即使血压没有下降，抑制ACE也可诱导左心室肥大的逆转。
新型血管紧张素II受体阻滞剂氯沙坦与ACE抑制剂一样，在动物模型中对心血管结构也显示出显著作用。
使用ACE抑制剂阻断肾素-血管紧张素系统似乎对逆转心脏肥大具有独立意义。然而，我们仍不清楚除血压下降外，局部或全身血管紧张素II的减弱是否是ACE抑制的最重要作用。因此，人们对未来比较血管紧张素II拮抗剂与ACE抑制剂影响左心室肥大能力的研究结果非常期待，特别是关于对心肌细胞肥大和间质纤维化的不同影响。
