裸帝寓言是否适用于当前肾素血管紧张素系统抑制在高血压中的作用?

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Carlos M Ferrario, Amit Saha, Jessica L VonCannon, Wayne J Meredith, Sarfaraz Ahmad
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引用次数: 2

摘要

综述目的:为了应对当代高血压的挑战,对血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂的治疗成果进行批判性的重新检查,并对随机临床试验中基于证据的缺陷进行更大的认识,是加快未来进展的基础。最新发现:针对血管紧张素II的药物作用机制对于治疗原发性高血压、2型糖尿病、心力衰竭和慢性肾脏疾病至关重要。虽然血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂控制血压的能力是无可争议的,但从业人员、高血压专家和研究人员对这些药物在预防或降低心血管事件风险方面的局限性认识不足。在解释从随机临床试验中获得的数据中获得的知识时存在偏差,包括普遍强调使用相对风险降低而不是绝对风险降低。此外,国际高血压指南中对临床实践的建议未能解决剩余风险比获益大几个数量级的重要性。我们分析了导致当前推荐治疗指南的临床试验的局限性。我们在已发表的高血压试验中定义并量化了剩余风险的大小,并探讨了肾素血管紧张素系统中替代代偿性生物处理成分的激活如何绕过血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂的能力,从而显著降低总死亡率和心血管死亡率。我们通过概述目前免疫疗法单独或可能与其他抗高血压药物联合阻断血管紧张素II病理的初期但有希望的潜力来完成本报告。充分认识到当前基于肾素血管紧张素系统的治疗相关的剩余风险的大小,是寻求新的分子方法来停止甚至逆转原发性高血压心血管并发症的重要基础,并鼓励研究新一代ACE抑制剂和arb,这些抑制剂和arb具有更大的能力到达可以产生Ang II的细胞内区室。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Does the Naked Emperor Parable Apply to Current Perceptions of the Contribution of Renin Angiotensin System Inhibition in Hypertension?

Does the Naked Emperor Parable Apply to Current Perceptions of the Contribution of Renin Angiotensin System Inhibition in Hypertension?

Purpose of review: To address contemporary hypertension challenges, a critical reexamination of therapeutic accomplishments using angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, and a greater appreciation of evidence-based shortcomings from randomized clinical trials are fundamental in accelerating future progress.

Recent findings: Medications targeting angiotensin II mechanism of action are essential for managing primary hypertension, type 2 diabetes, heart failure, and chronic kidney disease. While the ability of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers to control blood pressure is undisputed, practitioners, hypertension specialists, and researchers hold low awareness of these drugs' limitations in preventing or reducing the risk of cardiovascular events. Biases in interpreting gained knowledge from data obtained in randomized clinical trials include a pervasive emphasis on using relative risk reduction over absolute risk reduction. Furthermore, recommendations for clinical practice in international hypertension guidelines fail to address the significance of a residual risk several orders of magnitude greater than the benefits. We analyze the limitations of the clinical trials that have led to current recommended treatment guidelines. We define and quantify the magnitude of the residual risk in published hypertension trials and explore how activation of alternate compensatory bioprocessing components within the renin angiotensin system bypass the ability of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers to achieve a significant reduction in total and cardiovascular deaths. We complete this presentation by outlining the current incipient but promising potential of immunotherapy to block angiotensin II pathology alone or possibly in combination with other antihypertensive drugs. A full appreciation of the magnitude of the residual risk associated with current renin angiotensin system-based therapies constitutes a vital underpinning for seeking new molecular approaches to halt or even reverse the cardiovascular complications of primary hypertension and encourage investigating a new generation of ACE inhibitors and ARBs with increased capacity to reach the intracellular compartments at which Ang II can be generated.

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来源期刊
Current Hypertension Reports
Current Hypertension Reports 医学-外周血管病
CiteScore
10.50
自引率
0.00%
发文量
65
审稿时长
6-12 weeks
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of hypertension. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antihypertensive therapies, associated metabolic disorders, and therapeutic trials. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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