Angiotensin Blockade in Polycystic Kidney Disease多囊肾患者血管紧张素的阻断

Two double-blind, placebo-controlled trials concluded that in early autosomal dominant polycystic kidney disease (ADPKD), rigorous blood-pressure control was associated with a slower increase in total kidney volume, a greater decline in the left-ventricular-mass index, and greater reduction in urinary albumin excretion; monotherapy with an ACE inhibitor lisinopril was associated with blood-pressure control in most patients with ADPKD and stage 3 chronic kidney disease. The addition of an ARB telmisartan did not alter the decline in the estimated GFR. Hypertension develops early in patients with ADPKD and is associated with disease progression. The renin–angiotensin–aldosterone system is implicated in the pathogenesis of hypertension in patients with ADPKD. Source: http://www.nejm.org/两个双盲，安慰剂对照试验得出结论，在常染色体显性多囊肾（ADPKD）早期，严格控制血压与较慢的肾脏体积总量增加，较大的左心室质量指数下降，和更大幅度的尿白蛋白排泄降低有关;单用血管紧张素转化酶抑制剂赖诺普利与大部分并发三期慢性肾脏病的ADPKD患者的血压控制有关。加用一个血管紧张素受体阻断剂替米沙坦并未改变预估肾小球滤过率的下降。ADPKD患者早期即发生高血压且与疾病进展有关。肾素 – 血管紧张素 – 醛固酮系统涉及ADPKD患者高血压的发病机制。来源：http://www.nejm.org/疾病进展