In this article we emphasize the need for prompt intervention in diabetic patients with high blood pressure in order to protect the heart, brain, kidney, and the vascular tree against arteriosclerotic damage, which is...
详细信息
Current knowledge implicating the involvement of angiotensin II in both the development of hypertension and the pathophysiology of congestive heart failure, myocardial infarction, atherosclerosis, and vascular disease...
详细信息
Current knowledge implicating the involvement of angiotensin II in both the development of hypertension and the pathophysiology of congestive heart failure, myocardial infarction, atherosclerosis, and vascular disease will open the door for more clinical trials involving angiotensin receptor blockers. Current and future studies should clearly answer the question of whether these drugs will play a major role in reducing morbidity and mortality from these diseases. If possible, these studies should attempt to further explain the role of angiotensin II and its receptors in the development of cardiovascular diseases.
The renin-angiotensin system may contribute to the pathogenesis of atherosclerosis. A common feature of all stages of atherosclerosis is inflammation of the vessel wall. The transcription factor nuclear factor-kappa B...
详细信息
The renin-angiotensin system may contribute to the pathogenesis of atherosclerosis. A common feature of all stages of atherosclerosis is inflammation of the vessel wall. The transcription factor nuclear factor-kappa B (NF-kappa B) participates in most signaling pathways involved in inflammation, This study therefore examined the effect of angiotensin (ANG) II on NF-kappa B activation in monocytic cells, a major cellular component of human atheroma, by electrophoretic mobility shift assay. ANG II, like TNF alpha, caused rapid activation of NF-kappa B in human mononuclear cells isolated from peripheral blood by Ficoll density gradient. This ANG II effect was blocked by the angiotensin AT1 receptor antagonist losartan. Specificity of ANG II-induced NF-kappa B activation was ascertained by supershift and competition experiments. Moreover, ANG II stimulated NF-kappa B activation in human monocytes, but not in lymphocytes from the same preparation. Together, the data demonstrate the ability of the vasoactive peptide ANG II to activate inflammatory pathways in human monocytes. (C) 1999 Academic Press.
作者：
Pfeffer, MAHarvard Univ
Sch Med Brigham & Womens Hosp Div Cardiovasc Boston MA 02115 USA
Treatment of acute myocardial infarction (MI) has been advanced considerably in the past 20 years with the advent of acute reperfusion strategies such as thrombolytic therapy or primary angioplasty and the use of adju...
详细信息
Treatment of acute myocardial infarction (MI) has been advanced considerably in the past 20 years with the advent of acute reperfusion strategies such as thrombolytic therapy or primary angioplasty and the use of adjunctive medical therapies such as aspirin, beta-blockers, and HMG-CoA reductase inhibitors (statins);each has been proven to reduce morbidity and mortality rates after MI. Angiotensin-converting enzyme (ACE) inhibitors have earned an important place in this list of winners;particularly in patients clinically assessed as being at higher risk for cardiovascular death. The benefits of treating such patients with an ACE inhibitor have clearly shown significant improvements in survival thai are both complementary and additive to the other proven therapies. However, a significant subset of patients treated with ACE inhibitors will die or have worsening congestive heart failure despite adequate therapy. Appropriate risk stratification can help guide the clinician in identifying patients at greatest risk for cardiovascular events after MI. Fortunately, investigators are currently exploring the potential benefits of more specific and selective blockade of the renin-angiotensin system with AT(1) receptor blockers (ARBs) in the hope of enhancing survival beyond that evidenced with ACE inhibition alone. These agents pharmacologically inhibit the renin-angiotensin system at the angiotensin (Ang) II type 1 receptor level. Although there ore theories postulating why blocking the harmful effects of Ang II at this receptor would be more effective than inhibiting ACE-mediated conversion from inactive Ang I to Ang ii, extrapolation to the clinical setting remains highly speculative. These hypotheses can only be tested by direct comparisons of ACE inhibitors and ARBs in the appropriate patient populations. The VALIANT (Valsartan in Acute Myocardial Infarction) trial is testing the hypothesis that interruption of the renin-angiotensin pathway by using the ARE valsartan alone
暂无评论