Optimal dose of angiotensin‐converting enzyme inhibitor or angiotensin II receptor blocker for renoprotection-猫眼课题宝

血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂的肾脏保护最佳剂量

DOI：

10.1111/j.1440-1797.2010.01315.x

发表时间：

2010

期刊：

Nephrology

影响因子：

2.5

通讯作者：

中科院分区：

医学4区

文献类型：

作者：

F. Hou;Q. Zhou

Angiotensin‐converting enzyme inhibitors (ACEI) and angiotensin II type 1 receptor blockers (ARB) have become the cornerstone in the treatment of chronic kidney disease (CKD), as numerous lines of evidence have shown that these agents have a blood pressure lowing independent anti‐proteinuric effect. However, despite the benefits of ACEI or ARB therapy, a substantial proportion of patients still experience renal morbidity and mortality. Considering the prognostic impact of proteinuria reduction, it is currently assumed that titration of ACEI or ARB for optimal anti‐proteinuric effect would be a logical step towards improvement of renoprotection. Recent published studies, performed with higher than recommended doses of either ACEI or particularly ARB, suggest that the approach is associated with a further decrement in urinary protein excretion and probably improved renal outcome. Although most patients achieve their maximum benefit at standard doses, there is a residual group of patients who may do so at higher doses of renin‐angiotensin system inhibitors. Because patients who would benefit from higher doses are not identifiable a priori, a titration process might be cogent in order to provide more robust anti‐proteinuric benefit to such patients.