Renin-angiotensin-aldosterone system blockade for cardiovascular diseases: current status.

摘要: Activation of the renin–angiotensin–aldosterone system (RAAS) results in vasoconstriction, muscular (vascular and cardiac) hypertrophy fibrosis. Established arterial stiffness cardiac dysfunction are key factors contributing to subsequent cardiovascular renal complications. Blockade RAAS has been shown be beneficial patients with hypertension, acute myocardial infarction, chronic systolic heart failure, stroke diabetic disease. An aggressive approach for more extensive blockade combination two commonly used blockers [ACE inhibitors (ACEIs) angiotensin receptor (ARBs)] yielded conflicting different patient populations. Combination therapy is also associated side effects, particular hypotension, hyperkalaemia impairment. Recently published ONTARGET study showed ACEI/ARB was adverse effects without any increase benefit. The Canadian Hypertension Education Program responded a new warning: ‘Do not use ACEI ARB combination’. However, European Society Cardiology their updated failure treatment guidelines still recommended combo as viable option. This apparent inconsistency among generates debate which inhibition best. current paper reviews latest evidence isolated or diseases, makes recommendations prescriptions specific