血管紧张素转化酶抑制剂与血管紧张素受体阻滞剂治疗充血性心力衰竭效果对比

目的：研究分析对充血性心力衰竭患者采用血管紧张素受体阻滞剂和血管紧张素转化酶抑制剂治疗的效果,为其临床治疗和应用提供有效的理论依据。方法本次研究的开展时间为2013年1月-2014年1月,均为该阶段在本院接受治疗的充血性心力衰竭患者共208例,根据患者临床期间所接受的不同用药方案,将其随机分为两组,对照组患者104例,临床期间采用贝那普利片（血管紧张素转化酶抑制剂）治疗,观察组患者104例,临床期间采用缬沙坦片（血管紧张素受体阻滞剂）治疗,比较两组患者的治疗效果,研究中所涉及的数据采用 SPSS 统计软件进行分析处理。结果本研究中,观察组患者的治疗有效率为96.15％,对照组患者的治疗有效率为82.69％,观察组明显高于对照组,两组比较差异明显,具有统计学意义,P〈0.05。结论在充血性心力衰竭的治疗中,采用血管紧张素受体阻滞剂治疗的效果更佳,在临床治疗中应加以重视。     

心力衰竭病人β-受体阻滞剂、血管紧张素转化酶抑制剂的应用与血管紧张素Ⅱ水平

本研究旨在弄清心力衰竭应用血管紧张素转化酶抑制剂 (ＡＣＥＩ)的病人同时应用 β 受体阻滞剂是否可以降低病人血液血管紧张素Ⅱ水平。方法　研究对象为Ａｌｆｒｅｄ医院心脏中心的心力衰竭病人。心功能为Ⅱ～Ⅲ级 (ＮＹＨＡ标准 )。所有病人均接受最大耐受剂量ＡＣＥＩ治疗 ,测定病人用药治疗前、后血管紧张素水平。1 1例未用β 受体阻滞剂病人为Ａ组 ,1 1例应用最大耐受剂量β 受体阻滞剂病人为Ｂ组。于心导管检查时采集血样。Ａ组 1 0例、Ｂ组 9例应用襻利尿剂治疗。两组各有 3例应用了安体舒通治疗。Ａ组 7例应用卡托普利 2 5～1 0 0ｍ…     

合用钙通道阻滞剂和血管紧张素转换酶抑制剂治疗心血管疾病

本文简述钙通道阻滞剂和血管紧张素转换酶抑制剂在维持血管内皮功能、抑制内皮素作用和抗动脉粥样硬化等方面的协同作用,并提出需合用钙通道阻滞剂和血管紧张素转换酶抑制剂的临床情况。     

血管紧张素转化酶抑制剂与血管紧张素受体拮抗剂临床疗效对比

肾素-血管紧张素-醛固酮系统（RAAS）激活与高血压及其他心血管不良事件密切相关。虽然血管紧张素转化酶抑制剂（ACEI）与血管紧张素受体拮抗剂（ARB）在高血压治疗中同样重要,但研究发现二者心血管系统保护作用差异明显。本文将综述评估上述药物临床疗效的相关研究。     

血管紧张素转化酶抑制剂所致咳嗽与血管紧张素转化酶基因型相关性的研究

目的　探讨老年原发性高血压患者口服血管紧张素转换酶抑制剂 (ACEI )后发生咳嗽的机制。方法　应用聚合酶链反应 (PCR) ,检测老年原发性高血压患者口服ACEI后发生咳嗽与无咳嗽者的血管紧张素转化酶 (ACE)基因多态性 ,检测并比较两组患者血清ACE水平及ACE水平预测高血压患者口服ACEI引起咳嗽的敏感性和特异性。结果　ACEI所致咳嗽组ACE基因Ⅱ型的频率为4 0 % ,显著高于无咳嗽组 (2 0 % ,P <0 0 5 ) ,Ⅰ等位基因频率为 6 0 % ,显著高于无咳嗽组 (4 1% ,P <0 0 1)。两组患者血清ACE水平在DD型、ID型、Ⅱ型依次减低。咳嗽组血清ACE水平显著低于无咳嗽组 (P <0 0 0 1) ,血清ACE水平预测ACEI引起咳嗽的敏感性和特异性分别为 81%和 78%。结论　老年高血压患者口服ACEI所致咳嗽与血清ACE水平及ACE基因多态性有关。     

血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂联合治疗糖尿病肾病的临床研究

目的比较血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）单独及联合治疗糖尿病肾病（DN）的疗效。方法183例DN患者，随机分为三组，分别予贝那普利、洛沙坦或两药联合治疗12周。比较治疗前后血压、尿蛋白及血钾和血Cr等的变化。结果上述两药均能有效降低DN的血压和尿蛋白且作用相似；联合治疗的降尿蛋白作用更明显（P〈0．05），但二者的降压效果相似（P〉0．05）。治疗前后的血钾、血Cr和Ccr无明显变化（P〉0．05）。结论对于DiN患者，ACEI和ARB联合治疗与单药相比具有更强的降尿蛋白作用，且这种作用是通过独立于血压的机制实现的。     

血管紧张素Ⅱ受体阻滞剂和血管紧张素转换酶抑制剂有什么异同

肾素和血管紧张素系统(RAS)有2类效应类似而有区别的重要和常用药物：血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体阻滞剂(ARB)。     

左室重构与血管紧张素转化酶抑制剂

心室重构是指发生在急性心肌梗死(AMI)或其它严重心肌损伤之后的心室形态结构、空间构型、工作方式以及生化组份与基因调控等多方面的病理变化。其主要病因是AMI,且多发生于左心室,故又称为左室重构。原发性心肌损害和心脏负荷过重引起的室壁应力增加可能是心室重构的始动机制,而各种促生长因子起了重要的作用,其中血管紧张素Ⅱ(ATⅡ)可能是一系列生化反应的核心。限制和减轻AMI及左室重构是当前心血管领域中重要的研究内容之一。1986年Mckay RG等提出心室重构这一概念。并开始对这一病理过程进行了系列研究。本文就AMI后左室重构及血管紧张素转化酶抑制剂(ACEI)对其影响作一综述。     

钙通道阻滞剂联合血管紧张素Ⅱ受体阻滞剂在脑卒中预防中的临床意义

钙通道阻滞剂及血管紧张素Ⅱ受体阻滞剂均为降压达标且具预防脑卒中发生作用的降压药物.两类药物联用降压作用更加明显且在预防终点事件尤其在脑卒中方面应具有符合逻辑的优势,现综述两类药物预防脑卒中的循证证据、联合用药的作用及可能机制.     

血管紧张素转化酶抑制剂和血管紧张素受体拮抗剂与肾保护作用

目前认为肾素血管紧张素系统（RAS）参与了慢性肾脏疾病的进展,阻断RAS能延缓肾脏疾病进展。血管紧张素转化酶抑制剂（ACEI）及血管紧张素ⅡAT1受体拮抗剂（AT1RA）是阻断RAS的主要药物。本文就此两类药物的肾保护作用进行综述,以供临床用药参考。     

Endothelial dysfunction, angiotensin-converting enzyme inhibitors and calcium antagonists

The endothelium plays a crucial role in the pathogenesis of cardiovascular disease. Endothelial function is attenuated by the presence of different well known cardiovascular risk factors. Evaluation of endothelial vasodilator function serve as an index integrating the overall stress imposed by cardiovascular risk factors and reinforce the suggestion that endothelial dysfunction is an early marker of cardiovascular disease that precedes clinical manifestations. Angiotensin-converting enzyme inhibitors have been shown to reduce the cardiovascular mortality, an effect that could be the consequence of an improvement in the endothelial function. Recent studies have shown that a calcium antagonist might improve the endothelial function, however, there is controversy about this action and also about the potential mechanisms for the effect of a calcium antagonist in the regulation of endothelial function.     

Control of edema in hypertensive subjects treated with calcium antagonist (nifedipine) or angiotensin-converting enzyme inhibitors with Pycnogenol.

The presence of edema in different phases and stages of essential hypertension may be due to antihypertensive treatment. Some drugs may cause edema by inducing vasodilatation, increasing the capillary exchange surface and capillary filtration. Pycnogenol has an important anti-edema effect in diabetic microangiopathy and chronic venous insufficiency. This 8-week study evaluated capillary filtration in 2 comparable treatment groups with hypertension treated with a calcium antagonist (nifedipine) or angiotensin-converting enzyme inhibitor to define its efficacy in preventing edema caused by antihypertensives. A significant decrease in filtration was observed in the Pycnogenol groups. Pycnogenol controls this type of edema, it helps to prevent and limit long-term damage in the microcirculation in hypertensive patients, and allows the dose of anti-hypertensive drugs to be reduced in most patients.     

Effects of calcium antagonist, angiotensin-converting enzyme inhibitors and beta-blocker on hemodynamic and sympathetic nerve responses to exercise in essential hypertension]

To investigate the effects of antihypertensive drugs on hemodynamic and sympathetic nerve responses to exercise, graded ergometer exercise tests were performed before and after two-week administration of nifedipine, captopril and metoprolol in 18 patients with essential hypertension. The arterial pressure, heart rates (HR), and left ventricular functions as obtained by echocardiography, and the plasma norepinephrine (PNE) levels, were evaluated at rest and during submaximal exercise before and after two-week treatment with nifedipine (40 mg/day, 5 cases), captopril (37.5-75 mg/day, 6 cases) and metoprolol (60 mg/day, 7 cases). These 3 drugs significantly reduced systolic (SBP) and diastolic (DBP) blood pressures but caused no significant changes in resting PNE levels. Nifedipine produced no significant changes in HR and cardiac output (CO) at rest, but augmented the increase in HR (delta HR) and SBP (delta SBP) during submaximal exercise. The increase in PNE (delta PNE) was also augmented by nifedipine. Captopril reduced left ventricular end-diastolic volume and CO without changes in HR and fractional shortening (FS) at rest; whereas, it did not affect delta HR, delta CO, delta SBP or delta PNE during exercise. Metoprolol reduced HR and CO at rest, and also resulted in a decrease in delta FS and delta CO during submaximal exercise. delta SBP was unchanged and delta PNE was increased by treatment with metoprolol. These results indicate that, in hypertensive subjects, the effects on the hemodynamic and sympathetic nerve responses to exercise are different among these 3 antihypertensive drugs despite their identical effects on blood pressure.     

ACE2和ACE在自发性高血压大鼠心肌中的变化

目的:观察自发性高血压大鼠(SHR)心肌的血管紧张素转化酶(ACE)和ACE2的表达,以探讨ACE2和ACE在高血压发生发展中的变化。方法:取15只SHR,处死,分离左心室,行RT-PCR、Western blot蛋白质免疫印迹和免疫组织化学检测ACE及ACE2表达;同步取10只WKY大鼠作为正常血压对照组。结果:SHR组心肌ACE的mRNA和蛋白质表达都显著高于WKY组[(1.68±0.34)∶(0.33±0.12),P<0.05;(1.21±0.14)∶(0.71±0.11),P<0.05],而ACE2的mRNA和蛋白质表达皆明显低于WKY组[(0.50±0.15)∶(1.16±0.24),P<0.05;(0.71±0.24)∶(1.22±0.14),P<0.05)]。免疫组织化学染色显示,SHR组ACE的阳性率明显高于WKY组(87%∶50%,P<0.05),而ACE2的阳性率明显低于WKY组(27%∶70%,P<0.05)。结论:SHR心肌ACE明显升高,ACE2显著降低;SHR高血压发生发展过程中存在着ACE和ACE2表达的失衡。     

Use of calcium channel blockers and angiotensin-converting enzyme inhibitors after cardiac transplantation

PURPOSE OF REVIEW: Hypertension, dyslipidemia, and diabetes are very common problems following heart transplantation and may contribute to the development and progression of graft coronary artery disease. This article reviews current data on clinical use of angiotensin-converting enzyme inhibitors and calcium channel blockers in patients who have had heart transplants. RECENT FINDINGS: Angiotensin-converting enzyme inhibitors and calcium channel blockers are established therapy for patients with cardiovascular disease. Use of these medications correlates with decreasing cardiovascular morbidity and mortality. SUMMARY: After heart transplantation, hypertension associated with calcineurin inhibitors can be managed effectively with antihypertensive therapy, but it may require use of more than one antihypertensive agent. Calcium channel blockers and angiotensin-converting enzyme inhibitors have been associated with improved outcome measures in graft coronary artery disease.     

血管紧张素转化酶Ⅱ与血管紧张素转化酶在胰腺癌组织中的表达水平变化及相互关系

目的检测血管紧张素转化酶Ⅱ(ACE2)和血管紧张素转化酶(ACE)在人胰腺癌组织中的表达情况及相互间关系。方法采用逆转录-聚合酶链反应(RT-PCR)方法检测ACE2与ACE mRNA在14例胰腺癌患者的癌组织、癌旁组织(距癌边缘>5 cm)中的表达及两者的关联性;采用免疫组化法检测ACE2与ACE蛋白在92例胰腺癌患者的癌组织中的表达水平,统计分析两者表达的关联性及ACE2与胰腺癌临床病理特征的关系。结果 ACE2 mRNA在胰腺癌组织中的相对表达量显著低于癌旁组织,ACE mRNA在癌组织中的相对表达量则显著高于癌旁组织(P值均<0.05);ACE2蛋白在胰腺癌组织中的阳性表达率为22.8%(21/92),显著低于癌旁胰腺组织[57.6%(53/92),P<0.05];ACE在胰腺癌中的阳性表达率[85.9%(79/92)]则显著高于癌旁胰腺组织[44.6%(41/92),P<0.05]。胰腺癌组织中ACE2表达在基因及蛋白水平均与ACE表达呈负相关性(r值分别为-0.416和-0.475,P值均<0.05)。胰腺癌组织中ACE2蛋白的表达与胰腺癌的TNM分期密切相关(P<0.05)。结论 ACE2在胰腺癌中表达下调及ACE2与ACE表达比例失衡可能在胰腺癌的发生发展中起重要作用。     

Comparison of efficacy and side effects of combination therapy of angiotensin-converting enzyme inhibitor (benazepril) with calcium antagonist (either nifedipine or amlodipine) versus high-dose calcium antagonist monotherapy for systemic hypertension

The present 2 multicenter studies were designed to evaluate whether patients with essential hypertension derived equal benefits from use of combination therapy with a calcium antagonist and angiotensin-converting enzyme (ACE) inhibitor as from doubling the dose of the calcium antagonist. After a 2-week washout and a 2-week single-blind placebo run-in period, a total of 1,390 patients were treated with either nifedipine 30 mg (study 1) or amlodipine 5 mg (study 2) once daily for 4 weeks. The 1,079 patients whose diastolic blood pressure remained between 95 and 115 mm Hg were randomized to 8 weeks of double-blind therapy with amlodipine 5 mg/benazepril 10 mg, amlodipine 5 mg/ benazepril 20 mg, nifedipine 30 mg or nifedipine 60 mg (study 1), and amlodipine 5 mg/benazepril 10 mg, amlodipine 5 mg/benazepril 20 mg, amlodipine 5 mg or amlodipine 10 mg (study 2). Both doses of the calcium antagonist/ACE inhibitor combination therapy lowered diastolic pressure as much as the high dose and significantly better than the lower dose of calcium antagonist monotherapy (with either nifedipine or amlodipine). However, 15% of patients in the nifedipine high-dose monotherapy group and 24% in the amlodipine high-dose monotherapy group presented with some form of edema. In contrast, the incidence of edema was similar for patients treated with both combination therapy and low-dose calcium antagonists. Thus, combination therapy with a calcium antagonist and an ACE inhibitor provides blood pressure control equal to that of high-dose calcium antagonist monotherapy but with significantly fewer dose-dependent adverse experiences such as vasodilatory edema. Inc.     

Combination therapy with an angiotensin-converting enzyme inhibitor and a calcium channel blocker

More than 1 medication is required in many hypertensive patients to reach blood pressure (BP) goals, and initial treatment with 2 agents has been recommended for patients whose BP level is >20/10 mm Hg above target. Diuretics reduce BP levels and the incidence of target organ complications and together with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers, which are recommended in patients with comorbid cardiovascular disease, nephropathy, or diabetes, are effective antihypertensive combinations. Calcium channel blockers (CCBs) are also effective antihypertensive agents, and evidence suggests that a CCB/ACEI combination is well tolerated and also decreases the risk of cardiovascular and renal disease. Some evidence suggests that this combination may improve endothelial function more than either agent alone, and its use could potentially lead to better cardiovascular outcomes than a diuretic/ACEI or diuretic/ARB combination. The ongoing Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial compares these 2 effective combinations (ie, an ACEI/diuretic and ACEI/CCB) as initial treatment for reducing cardiovascular morbidity and mortality in older high-risk hypertensive patients. The results of this trial, when reported, should help to clarify the relative benefits of these different therapies.