Combined therapy for chronic kidney disease with angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor antagonist：right and wrong aspects.

doi:10.7504/nk2014080205

Acta Metallurgica Sinica

Previous Articles Next Articles

Combined therapy for chronic kidney disease with angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor antagonist：right and wrong aspects.

WANG Li-yan，LIU Wen-hu.

Department of Nephrology，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China

Online:2014-09-01 Published:2014-09-05

血管紧张素转换酶抑制剂联合血管紧张素Ⅱ受体拮抗剂治疗慢性肾脏疾病的利弊

王丽妍，刘文虎

作者单位：首都医科大学附属北京友谊医院肾内科首都医科大学肾病学系，北京 100050

作者简介: 刘文虎，主任医师、教授、博士生导师。首都医科大学附属北京友谊医院肾内科主任、首都医科大学肾病学系主任。兼任中华医学会肾脏病学分会常务委员、中国医师协会肾脏病医师分会常务委员等职；《中华肾脏病杂志》、《中国血液净化》、《中国全科医学》等期刊编委。承担北京市科委课题2项。发表论文50余篇，SCI收录期刊论文十余篇。 
基金资助:
北京市科学技术委员会科技计划重大项目课题(D131100004713001)

Abstract

Abstract:

Abstract：Over activation of rennin angiotensin aldosterone system (RAAS) usually exists in patients with chronic kidney disease (CKD)，which is an important pathophysiological factor for the progression of CKD.As effective inhibitors of RAAS，angiotensin-converting enzyme inhibitor (ACEI) and angiotensin Ⅱ receptor antagonist (ARB) are widely used in clinical treatment of patients with CKD，due to their antihypertensive effects and target organ protection.They are also recommended as the first-line drugs by most guidelines.But how to use of the drugs rationally has not yet reached a consensus.In this review，we discuss the effects of ACEI and ARB used in combination or alone，selection of the dosage，and reasonable prescriptions of them in treatment of CKD.

Key words: chronic kidney disease, angiotensin-converting enzyme inhibitor, angiotensin Ⅱ receptor blocker

摘要：

慢性肾脏病(CKD)患者通常存在肾素-血管紧张素-醛固酮系统(RAAS)的过度激活，是疾病进展的重要病理生理因素。针对RAAS的干预药物--血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体拮抗剂(ARB)，因具有降压和保护靶器官的作用，被广泛用于临床CKD患者的治疗中，也是多数指南推荐的一线药物。但如何合理应用该类药物目前尚未达成一致观点。文章就单独或联合使用ACEI和ARB治疗CKD的效果、药物剂量的选择，以及临床上如何合理应用此类药物等问题的最新观点做一综述。

关键词: 慢性肾脏疾病, 血管紧张素转换酶抑制剂, 血管紧张素Ⅱ受体拮抗剂

CLC Number:

R692

WANG Li-yan，LIU Wen-hu.. Combined therapy for chronic kidney disease with angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor antagonist：right and wrong aspects.[J]. Acta Metallurgica Sinica, DOI: 10.7504/nk2014080205.

王丽妍，刘文虎. 血管紧张素转换酶抑制剂联合血管紧张素Ⅱ受体拮抗剂治疗慢性肾脏疾病的利弊[J]. 中国实用内科杂志, DOI: 10.7504/nk2014080205.

References

［1］Ramaha A，Patston PA.Release and degradation of angiotensin I and angiotensin Ⅱ from angiotensinogen by neutrophil serine proteinases ［J］.Arch Biochem Biophys，2002，397(1)：77-83.

［2］Kim S，Izumi Y，Izumiya Y，et al.Beneficial effects of combined blockade of ACE and AT1 receptor on intimal hyperplasia in balloon-injured rat artery ［J］.Arterioscler Thromb Vasc Biol，2002，22(8)：1299-1304.

［3］Wright JT Jr，Bakris G，Greene T，et al.Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease：results from the AASK trial ［J］.JAMA，2002，288(19)：2421-2431.

［4］Viberti G，Wheeldon NM.Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus：a blood pressure-independent effect ［J］.Circulation，2002，106(6)：672-678.

［5］Yanagi M，Tamura K，Fujikawa T，et al.The angiotensin Ⅱ type 1 receptor blocker olmesartan preferentially improves nocturnal hypertension and proteinuria in chronic kidney disease ［J］.Hypertens Res，2013，36(3)：262-269.

［6］Izzo JL Jr，Purkayastha D，Hall D，et al.Comparative efficacy and safety of amlodipine/benazepril combination therapy and amlodipine monotherapy in severe hypertension ［J］.J Hum Hypertens，2010，24(6)：403-409.

［7］Molnar MZ，Kalantar-Zadeh K，Lott EH，et al.Angiotensin-converting enzyme inhibitor，angiotensin receptor blocker use，and mortality in patients with chronic kidney disease ［J］.J Am Coll Cardiol，2014，63(7)：650-658.

［8］Schmieder RE，Klingbeil AU，Fleischmann EH，et al.Additional antiproteinuric effect of ultrahigh dose candesartan：a double-blind，randomized，prospective study ［J］.J Am Soc Nephrol，2005，16(10)：3038-3045.

［9］Burgess E，Muirhead N，de Cotret P R，et al.Supramaximal dose of candesartan in proteinuric renal disease ［J］.J Am Soc Nephrol，2009，20(4)：893-900.

［10］Campbell R，Sangalli F，Perticucci E，et al.Effects of combined ACE inhibitor and angiotensin Ⅱ antagonist treatment in human chronic nephropathies ［J］.Kidney Int，2003，63(3)：1094-1103.

［11］Nakamura T，Inoue T，Sugaya T，et al.Beneficial effects of olmesartan and temocapril on urinary liver-type fatty acid-binding protein levels in normotensive patients with immunoglobin A nephropathy ［J］.Am J Hypertens，2007，20(11)：1195-1201.

［12］Krairittichai U，Chaisuvannarat V.Effects of dual blockade of renin-angiotensin system in type 2 diabetes mellitus patients with diabetic nephropathy ［J］.J Med Assoc Thai，2009，92(5)：611-617.

［13］Bakris GL，Ruilope L，Locatelli F，et al.Treatment of microalbuminuria in hypertensive subjects with elevated cardiovascular risk：results of the IMPROVE trial ［J］.Kidney Int，2007，72(7)：879-885.

［14］Yusuf S，Teo KK，Pogue J，et al.Telmisartan，ramipril，or both in patients at high risk for vascular events ［J］.N Engl J Med，2008，358(15)：1547-1559.

［15］林善锬.慢性肾脏疾病合并高血压处理的策略［J］.中国实用内科杂志，2010，30(2)：104-106.

［16］Chen YR，Yang Y，Wang SC，et al.Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan：a 3-year prospective cohort study ［J］.Nephrol Dial Transplant，2013，28(3)：671-682.

［17］Vogt L，Navis G，de Zeeuw D.Individual titration for maximal blockade of the renin-angiotensin system in proteinuric patients：a feasible strategy ［J］.J Am Soc Nephrol，2005，16(Suppl 1)：S53-57.

［18］Laverman GD，Bakker SJ，Navis GJ.Optimal dosing of renin-angiotensin-aldosterone system blockers for renal protection：a solved issue ［J］.Diabetologia，2009，52(6)：1217-1218.

［19］Hou FF，Xie D，Zhang X，et al.Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study：a randomized controlled study of benazepril and losartan in chronic renal insufficiency ［J］.J Am Soc Nephrol，2007，18(6)：1889-1898.

［20］Slagman MC，Navis G，Laverman GD.Dual blockade of the renin-angiotensin-aldosterone system in cardiac and renal disease ［J］.Curr Opin Nephrol Hypertens，2010，19(2)：140-152.

［21］程庆砾.慢性肾脏病合并心肾综合征的处理策略［J］.中国实用内科杂志，2010，30(2)：110-113.

［22］Esnault VL，Ekhlas A，Nguyen JM，et al.Diuretic uptitration with half dose combined ACEI + ARB better decreases proteinuria than combined ACEI + ARB uptitration ［J］.Nephrol Dial Transplant，2010，25(7)：2218-2224.

2014-04-12收稿 2014-06-06修回本文编辑：颜廷梅

[1]	JIANG Xiao，CHEN Nan.. Diagnosis and treatment of hypertension in chronic kidney disease：guidelines and controversies. [J]. Acta Metallurgica Sinica, 2014, 34(6): 572-575.
[2]	TANG Zheng，CHEN Sha-sha.. Comprehensive treatment in preventing progression of chronic kidney disease in elderly patients [J]. Acta Metallurgica Sinica, 2014, 34(12): 1144-1146.
[3]	YUE Rong-zheng，FU Ping.. Clinical evaluation and management of chronic kidney disease in the elderly [J]. Acta Metallurgica Sinica, 2014, 34(12): 1135-1138.
[4]	CAI Guang-yan，CHEN Xiang-mei.. Prevention，diagnosis，and treatment of kidney diseases in the elderly：current status and perspectives [J]. Acta Metallurgica Sinica, 2014, 34(12): 1133-1134.
[5]	LAI Wei-jing，LIU Fang，FU Ping.. Interpretation of clinical practice guideline for the evaluation and management of chronic kidney disease：from K/DOQI to KDIGO. [J]. Acta Metallurgica Sinica, 2013, 33(6): 448-453.
[6]	ZHANG Ling，YAN Cai-yun.. Scheduling of parathyroidectomy for refractory secondary hyperparathyroidism. [J]. , 2013, 33(2): 131-133.
[7]	ZUO Li. Revisiting management of renal anemia:correlation between hemoglobin variability and prognosis. [J]. , 2012, 32(12): 903-906.
[8]	LIN Pan，DING Xiao-qiang. Definition and cause of hyporesponsiveness to erythropoiesisstimulating agent. [J]. , 2012, 32(12): 903-906.
[9]	FU Ping，CHEN Xiao-lei.. Appropriate management of anemia with human erythropoietin in chronic kidney disease. [J]. , 2012, 32(12): 900-902.

Combined therapy for chronic kidney disease with angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor antagonist：right and wrong aspects.

血管紧张素转换酶抑制剂联合血管紧张素Ⅱ受体拮抗剂治疗慢性肾脏疾病的利弊

PDF

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 9

Recommended Articles

Metrics