Rationale for combining blockers of the renin-angiotensin system.

Détails

ID Serval
serval:BIB_BFC986F57568
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Rationale for combining blockers of the renin-angiotensin system.
Périodique
Seminars in Nephrology
Auteur(s)
Azizi M., Wuerzner G.
ISSN
0270-9295 (Print)
ISSN-L
0270-9295
Statut éditorial
Publié
Date de publication
2007
Volume
27
Numéro
5
Pages
544-554
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; ReviewPublication Status: ppublish
Résumé
Blockade of the renin-angiotensin system (RAS) with angiotensin I-converting enzyme (ACE) inhibitors and AT1-receptor (AT1R) blockers has become one of the most successful therapeutic approaches in medicine. The question is no longer whether RAS inhibition helps, but rather how we can optimize inhibition to achieve optimal cardiovascular and renal protection. Indeed, numerous data have shown that the RAS is not blocked fully over 24 hours with current doses of RAS blockers because they trigger a counter-regulatory renin release that can offset pharmacologic inhibition of the RAS. This absence of full blockade may have clinical implications. Combination therapy with ACE inhibitors and AT1R antagonists thus has been proposed to inhibit the biological effects of the reactive renin release triggered by single-site RAS inhibition. By using this approach, numerous experimental and clinical studies have suggested that this combination therapy has additive or synergistic effects on blood pressure and on the prevention of cardiovascular and renal lesions. Although similar intensity of RAS blockade can be achieved by either combination therapy or by using high doses of an AT1-receptor antagonist given alone, the ACE inhibitor present in the combination interferes with the bradykinin-nitric oxide pathway and the N-acetyl-Ser-Asp-Lys-Pro metabolism, which both may have additional biological effects.
Mots-clé
Angiotensin II Type 1 Receptor Blockers/therapeutic use, Angiotensin-Converting Enzyme Inhibitors/therapeutic use, Animals, Blood Pressure/drug effects, Cardiovascular Diseases/metabolism, Cardiovascular Diseases/prevention & control, Drug Therapy, Combination, Humans, Kidney Diseases/metabolism, Kidney Diseases/prevention & control, Renin-Angiotensin System/drug effects, Treatment Outcome
Pubmed
Création de la notice
13/03/2013 16:35
Dernière modification de la notice
03/03/2018 21:04
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