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Inhibitory angiotenzin konvertujícího enzymu a blokátory receptorů pro angiotenzin II v léčbě fibrilace síní


Authors: M. J. Levine;  P. Schweitzer
Authors‘ workplace: Division of Cardiology, Department of Medicine, Beth Israel Medical Center, New York, N. Y., USA
Published in: Vnitř Lék 2010; 56(11): 1138-1141
Category: Reviews

Overview

Fibrilace síní je nejčastější klinicky významnou arytmií a významnou příčinou morbidity a hospitalizací. Fibrilace síní je navíc spojena s významným rizikem tromboembolických příhod, obzvláště cerebrovaskulárních. Uvažujeme‑li nejběžnější rizikové faktory spojené s fibrilací síní, je hypertenze faktorem, který s fibrilací síní koreluje nejsilněji, a je také rizikovým faktorem nejčastějším. Renin‑angiotenzin‑aldosteronový systém představuje primární cíl léčby hypertenze za použití inhibitorů angiotenzin‑konvertujícího enzymu a blokátorů receptorů pro angiotenzin II. Při použití těchto léčivých přípravků bylo kromě kontroly krevního tlaku prokázáno snížení výskytu fibrilace síní. Tato léčiva jsou na buněčné úrovni účinná v prevenci fibrózy síní. Mohou navíc zabraňovat rozvoji fibrilace síní, zkracovat dobu trvání fibrilace síní a podporovat elektrickou kardioverzi u pacientů s touto arytmií. Pacienti s fibrilací síní nebo s rizikem fibrilace síní proto mohou mít prospěch z léčby antagonisty renin‑angiotenzin‑aldosteronového systému; tato léčiva jim přinesou terapeutické výhody přesahující prostou kontrolu krevního tlaku.

Klíčová slova:
inhibitory angiotenzin‑konvertujícího enzymu –  blokátory receptorů pro angiotenzin II –  fibrilace síní –  antagonisté renin‑angiotenzin‑aldosteronového systému –  cerebrovaskulární příhoda


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