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1、ACEI&CardiovasculardiseaseNeurohormonalActivationin MyocardialIschemicandHeartFailureAfterRemme.EurHeartJ.1998;19(SupplF):F62-F71.MyocardialischemiaRASactivationSystemic VasoconstrictionVasoconstrictionof coronaryarteries(bothlargeandsmall)SNSactivation?Adrenergictone?MVO2Renin-AngiotensinAldostero
2、neSystemcirculatinghormonalsystemlocalendogenoustissuehormonalsystemwithautocrineandparacrineeffectsneurotransmitterandneuromodulatorActionofAngiotensinIITISSUEAFFECTEDACTIONArteryStimulatescontraction,growthAdrenalStimulatessecretionofaldosteroneKidneyInhibitsreleaseofrenin Increasestubularreabsor
3、ptionofsodium Stimulatesvasoconstriction ReleaseprostaglandinsBrainStimulatesthirstandthereleaseofvaospressinSympatheticIncreasescentralsympatheticoutflow nervousFacilitatesperipheralsympathetictransmission systemIncreasesadrenalreleaseofepinephrineHeartIncreasescontractilityandventricularhypertrop
4、hyGoodfriendetal.NEJM1996;334:1649-1654.CardioprotectiveEffectsofACEIRestoringthebalancebetweenmyocardialoxygensupplyanddemandReductioninLVpreloadandafterloadReductioninLVmassReductioninsympatheticstimulationBeneficialeffectonreperfusioninjury*EvaLonn,etal.Circulation1994;90(4):2056-69.*Notdemonstr
5、atedconclusivelyinhumansAngiotensinIAngiotensinII1.vasoconstriction(systemicandcoronary)2.sympatheticnervoussystem(centralandperipheral)ACEIVasculoprotectiveEffectsofACEIDirectantiatherogeniceffect*Antiproliferativeandantimigratoryeffectsonsmoothmusclecells,neutrophilsandmononuclearcellsImprovement
6、and/orrestorationofendothelialfunctionProtectionfromplaquerupture*AntiplateleteffectsEnhancementofendogenousfibrinolysis*AntihypertensiveeffectsImprovementinarterialcomplianceandtoneEvaLonn,etal.Circulation1994;90(4):2056-69.*NotdemonstratedconclusivelyinhumansUseofACEIintheManagement ofCardiovascu
7、larDiseaseHypertensionSevereCHFModerateLVdysfunctionwithorwithoutMIHigh-riskpatientsformajorcardiovascularevents?-receptorantagonists&HeartfailureHeartFailureSocietyofAmerica(HFSA)PracticeGuidelines.JCardia
