Nicholls M G, Richards A M, Agarwal M
Department of Medicine, Christchurch Hospital, New Zealand.
J Hum Hypertens. 1998 May;12(5):295-9. doi: 10.1038/sj.jhh.1000638.
The renin-angiotensin system is central to the pathophysiology of a number of cardiovascular disorders. Most obviously this is so with renin secreting tumours, but the system is of central importance in other disorders such as scleroderma renal crisis and most cases of malignant hypertension. Activation of the renin-angiotensin system in unilateral renal artery stenosis is pivotal to the development of hypertension and the disturbances in electrolyte and volume balance -- most particularly in the hyponatraemic-hypertensive syndrome. Likewise, stimulation of the renin-angiotensin system is an important contributor, amongst many other systems, to the pathophysiology of cardiac failure. In diabetic nephropathy, the renin-angiotensin system is often suppressed as gauged by circulating levels of renin, yet it appears to make an important contribution to the progressive decline in renal function. Much less clear is the role of the renin-angiotensin system in essential hypertension insofar as it contributes to the level of blood pressure, to the development of left ventricular hypertrophy, and in the evolution of complications such as stroke and myocardial infarction. Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors has contributed to our understanding of the role of this system in cardiovascular disease. The advent of selective angiotensin II type-1 receptor blockers will further increase knowledge in this area.
肾素-血管紧张素系统在多种心血管疾病的病理生理学中起着核心作用。最明显的是在肾素分泌肿瘤中，该系统确实如此，但在其他疾病如硬皮病肾危象和大多数恶性高血压病例中，该系统也至关重要。单侧肾动脉狭窄时肾素-血管紧张素系统的激活对于高血压的发展以及电解质和容量平衡紊乱——尤其是低钠血症-高血压综合征——起着关键作用。同样，在许多其他系统中，肾素-血管紧张素系统的刺激是心力衰竭病理生理学的一个重要因素。在糖尿病肾病中，根据肾素的循环水平判断，肾素-血管紧张素系统常常受到抑制，然而它似乎对肾功能的逐渐下降起着重要作用。肾素-血管紧张素系统在原发性高血压中对血压水平、左心室肥厚的发展以及中风和心肌梗死等并发症的演变所起的作用则不太清楚。用血管紧张素转换酶抑制剂阻断肾素-血管紧张素系统有助于我们了解该系统在心血管疾病中的作用。选择性血管紧张素II 1型受体阻滞剂的出现将进一步增加这一领域的知识。
