Blokering af renin-angiotensin-systemet. ACE-haemmer, angiotensin II-antagonists eller både-og?
Engelsk titel: Blockade of the renin-angiotensin system. ACE inhibitors, angiotensin II antagonists or both?
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Författare:
Karlsen FM
;
Kamper AL
Email: fmk@mfi.ku.dk
Språk: Dan
Antal referenser: 20
Dokumenttyp:
Artikel
UI-nummer: 03101592
Sammanfattning
The renin-angiotensin system (RAS) is activated in several diseases, and angiotensin II mediates a number of putative detrimental effects through activation of the angiotensin II type 1 receptor, while the clinical role of the type 2 receptor remains unsettled. Inhibition of the RAS is either achieved by the use of angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists (AIIA). Although a combined inhibitory therapy might seem attractive, thus far limited data have emerged to support such a strategy. In hypertension, losartan has proven slightly more efficient than atenolol to prevent cardiovascular complications, overall mortality was, however, identical. In heart failure, AIIA should only be considered in ACE-inhibitor intolerant patients. Both ACE-inhibitors and AIIA have proven efficient in diabetic microalbuminuria and in proteinuria. ACE-inhibitors are first-line treatment in type 1 diabetic nephropathy, while AIIA are highly efficient in type 2 diabetic nephropathy. Combination therapy is superior to monotherapy in non-diabetic nephropathy.