Left ventricular (LV) dysfunction and/or heart failure (HF) are frequent complications of hypertension and myocardial infarction (MI), placing affected patients at increased risk of significant morbidity and premature death. Given that the renin-angiotensin-aldosterone system (RAAS) is activated and of pathophysiological importance in such patients, a strong therapeutic rationale exists to target the main effector mechanism (that is, angiotensin II [Ang II]) in order to lessen the associated morbidity and mortality burden. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce mortality and LV dysfunction and to slow disease progression in patients with HF, including high-risk, post-MI patients. However, ACE inhibitors (ACE-Is) may not provide optimal long-term RAAS blockade (a finding that is associated with a worse prognosis) and many patients are unable to tolerate such therapy (because of troublesome dry cough, for example). In contrast, Ang II receptor blockers (ARBs) may block the RAAS more completely than ACE-Is and appear to be better tolerated. Several large-scale trials gave evaluated the efficacy of ARBs in patients with LV dysfunction and/or HF (including high-risk, post-MI patients), and have confirmed their utility as an efficacious and well-tolerated alternative to ACE-Is in this setting.

译文

:左心室(LV)功能障碍和/或心力衰竭(HF)是高血压和心肌梗塞(MI)的常见并发症,使受影响的患者罹患显着发病率和过早死亡的风险增加。鉴于肾素-血管紧张素-醛固酮系统(RAAS)已被激活并且在此类患者中具有重要的病理生理意义,因此存在针对主要效应机制(即血管紧张素II [Ang II])的强大治疗原理,以减轻相关的疾病。发病率和死亡率负担。血管紧张素转换酶(ACE)抑制剂已被证明可以降低HF患者(包括高危MI后患者)的死亡率和LV功能障碍,并减缓疾病进展。但是,ACEI(ACE-Is)可能无法提供最佳的长期RAAS阻断作用(这一发现与更坏的预后相关),并且许多患者无法忍受此类治疗(例如,由于干咳引起的麻烦)。相比之下,Ang II受体阻滞剂(ARBs)可能比ACE-Is更完全地阻断RAAS,并且似乎具有更好的耐受性。几项大规模试验评估了ARB在LV功能不全和/或HF患者(包括高风险,MI后患者)中的疗效,并证实了其作为ACE-Is的有效且耐受性良好的替代品的用途。此设置。

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