Angiotensin-converting enzyme inhibitors versus AT1 receptor antagonist in cardiovascular and renal protection:: The case for AT1 receptor antagonist
Angiotensin-converting enzyme inhibitors versus AT1 receptor antagonist in cardiovascular and renal protection:: The case for AT1 receptor antagonist
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DOI：
10.1097/01.asn.0000093235.09769.9c
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发表时间：
2004-01-01
影响因子：
13.6
通讯作者：
Berl, T
中科院分区：
文献类型：
--
作者：
Berl, T
直接抑制血管紧张素II受体的药物(血管紧张素受体阻滞剂[ARB])的发展为临床医生提供了一种替代先前可用的血管紧张素转换酶抑制剂(ACEI)来下调肾素-血管紧张素系统的方法。这篇综述集中于现有的数据，可以指导临床医生使用这两类药物，比较它们提供心血管(CV)和肾脏保护的能力。尽管ACEI在高危人群中的心血管保护作用得到了广泛的认可，但这种作用是否完全依赖于BP仍是值得怀疑的。ACEI和ARB之间的大多数直接比较都产生了类似的心血管保护作用，ARB与较少的不良反应相关。同样，几项(但不是全部)研究表明，与其他活性药物相比，ACEI对2型糖尿病患者具有心血管保护作用。一项研究表明，与β受体阻滞剂相比，ARB具有类似的保护作用。在肾脏保护方面，有足够的数据支持ACEI和ARB在预防1型和2型糖尿病患者从微量蛋白尿发展为显性蛋白尿方面的作用。然而，当肾脏疾病进展作为终点时，ACEI仅对1型糖尿病有保护作用，而对2型糖尿病没有保护作用。在后一组中，只有ARB被证明延缓了向ESRD的进展。
The development of pharmacologic agents that directly inhibit the angiotensin II receptor (angiotensin receptor blocker [ARB]) has provided clinicians with an alternative to the previously available angiotensin-converting enzyme inhibitors (ACEI) to downregulate the renin-angiotensin system. This review focuses on the available data that can guide the clinician to the use of these two classes of agents vis A vis their ability to provide cardiovascular (CV) and renal protection. Although the CV protective effect of ACEI in high-risk populations is widely appreciated, whether such an effect is entirely BP independent can be questioned. Most head-to-head comparisons between ACEI and ARB have yielded comparable CV protective effects, with ARB being associated with fewer adverse effects. Likewise, several-but not all-studies have demonstrated a CV protective effect of ACEI when compared with other active agents in patients with type 2 diabetes. One study demonstrated a similar protection with ARB when compared with a beta blocker. In terms of renal protection, there are ample data to support a role for both ACEI and ARB to prevent the progression from microalbuminuria to overt albuminuria in both type 1 and type 2 diabetes. However, when progression of renal disease is used as an end point, protection has been demonstrated with ACEI only for type 1 but not type 2 diabetes. In this latter group, only ARB have been shown to slow progression to ESRD.