Renal dysfunction is common in patients with heart failure(HF) and can complicate HF therapy.Treating patients with HF and kidney disease is difficult and requires careful assessment,monitoring and balancing of risk b...Renal dysfunction is common in patients with heart failure(HF) and can complicate HF therapy.Treating patients with HF and kidney disease is difficult and requires careful assessment,monitoring and balancing of risk between potential benefits of treatment and adverse impact on renal function.In this review,we address the pathophysiological contexts and management options in this adversarial relation between the heart and the kidney,which exists in a substantial proportion of HF patients.Angiotensin converting enzyme inhibitors and β-blockers are associated with similar reductions in mortality in patients with and without renal insufficiency but usually are less often prescribed in patients with renal insufficiency.Careful monitoring of side effects and renal function should be done in all patients with renal insufficiency and prompt measures should be adopted to prevent further complications.展开更多
Inhibition of the renin angiotensin system has beneficial effects in cardiovascular prevention and treatment. The advent of orally active direct renin inhibitors adds a novel approach to antagonism of the renin-angiot...Inhibition of the renin angiotensin system has beneficial effects in cardiovascular prevention and treatment. The advent of orally active direct renin inhibitors adds a novel approach to antagonism of the renin-angiotensin system.Inhibition of the first and rate-limiting step of the renin angiotensin cascade offers theoretical advantages over downstream blockade.However,the recent discovery of the(pro)renin receptor which binds both renin and prorenin,and which can not only augment catalytic activity of both renin and prorenin in converting angiotensinogen to angiotensinⅠ,but also signal intracellularly via various pathways to modulate gene expression,adds a significant level of complexity to the field.In this review,we will examine the basic and clinical data on renin and its inhibition in the context of cardiovascular pathophysiology.展开更多
文摘Renal dysfunction is common in patients with heart failure(HF) and can complicate HF therapy.Treating patients with HF and kidney disease is difficult and requires careful assessment,monitoring and balancing of risk between potential benefits of treatment and adverse impact on renal function.In this review,we address the pathophysiological contexts and management options in this adversarial relation between the heart and the kidney,which exists in a substantial proportion of HF patients.Angiotensin converting enzyme inhibitors and β-blockers are associated with similar reductions in mortality in patients with and without renal insufficiency but usually are less often prescribed in patients with renal insufficiency.Careful monitoring of side effects and renal function should be done in all patients with renal insufficiency and prompt measures should be adopted to prevent further complications.
基金Supported by(in part)a research grant from Novartis Pharmaceuticals to Joseph J
文摘Inhibition of the renin angiotensin system has beneficial effects in cardiovascular prevention and treatment. The advent of orally active direct renin inhibitors adds a novel approach to antagonism of the renin-angiotensin system.Inhibition of the first and rate-limiting step of the renin angiotensin cascade offers theoretical advantages over downstream blockade.However,the recent discovery of the(pro)renin receptor which binds both renin and prorenin,and which can not only augment catalytic activity of both renin and prorenin in converting angiotensinogen to angiotensinⅠ,but also signal intracellularly via various pathways to modulate gene expression,adds a significant level of complexity to the field.In this review,we will examine the basic and clinical data on renin and its inhibition in the context of cardiovascular pathophysiology.
