Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies.
Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies.
复制标题
参与从高血压到肥厚再到心力衰竭转变的途径。
DOI：
10.1007/s10741-007-9060-z
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发表时间：
2008
影响因子：
4.6
通讯作者：
Harding,JosephW
中科院分区：
文献类型：
--
作者：
Wright,JohnW;Mizutani,Shigehiko;Harding,JosephW
肾素-血管紧张素-醛固酮系统（RAAS）在调节全身血压、水和电解质平衡以及脑垂体激素方面至关重要。这些生理学似乎主要由血管紧张素II/AT 1受体亚型系统介导。该系统的过度刺激可易患以过度血管收缩、纤维化和心脏重塑为特征的心血管疾病（CVD）。如果不治疗，患者通常表现出从动脉粥样硬化到左心室肥大（LVH）、冠状动脉血栓形成、心肌梗死的连续病理生理状况，其中心力衰竭作为终点。抗高血压治疗的干预是必要的，以抑制这种进展。RAAS阻断药物似乎是最有效的方法。舒张性心力衰竭患者可从血管紧张素转换酶（ACE）抑制剂和血管紧张素AT 1受体阻滞剂（ARB）治疗中获益。老年心血管疾病患者的身体组成发生了与年龄相关的变化，这些变化改变了药物的分布和半衰期，因此对治疗提出了特殊的挑战。合并症如糖尿病、肾功能不全、肝功能不全的存在使任何治疗策略进一步复杂化。此外，由于认知障碍、抑郁、给药方案复杂性引起的混乱以及缺乏适当的社会支持系统而导致的不依从性可能会破坏积极的结果。本综述讨论了过度活跃的RAAS和交感神经系统作为CVD的主要贡献者的作用。此外，治疗策略进行了讨论，重点是中老年高血压和心力衰竭患者。
The renin-angiotensin-aldosterone system (RAAS) is critical in regulating systemic blood pressure, water and electrolyte balance, and pituitary gland hormones. These physiologies appear to be primarily mediated by the angiotensin II/AT1receptor subtype system. Overstimulation of this system can predispose cardiovascular disease (CVD) characterized by excessive vasoconstriction, fibrosis, and cardiac remodeling. If untreated, the patient typically displays a continuum of pathophysiologic conditions progressing from atherosclerosis to left ventricle hypertrophy (LVH), coronary thrombosis, myocardial infarcts, with heart failure as an endpoint. Intervention with antihypertensive therapy is necessary to inhibit this progression. RAAS blocking drugs appear to be the most effective approach. Diastolic heart failure patients benefit from treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin AT1receptor blockers (ARBs). Elderly CVD patients evidence age-related changes in body composition that alter the distribution and half-life of medications, thus presenting special challenges to treatment. The presence of comorbidities such as diabetes, renal dysfunction, liver insufficiency further complicates any therapeutic strategy. In addition, noncompliance because of cognitive impairment, depression, confusion due to the complexity of dose regimens, and lack of an appropriate social support system can disrupt positive outcome. The present review discusses the roles of an overactive RAAS and sympathetic nervous system as primary contributors to CVD. In addition, treatment strategies are discussed, focusing on middle aged and elderly hypertensive and heart failure patients.