循環器ジャーナル65巻4号

2017年10月発行

特集 ACSの診断と治療はどこまで進歩したのか Ⅳ．ACSの二次予防

ACS患者におけるACE-I，ARB，MRA

著者： 神田大輔¹ 大石充¹

所属機関： ¹鹿児島大学医歯学総合研究科心臓血管・高血圧内科学

ページ範囲：P.690 - P.696

Point
・ACE-I/ARBの予後改善効果は，ACS（急性冠症候群）時に過剰に賦活化されたRA系を遮断し，アルドステロンⅡ産生を抑制することにより発揮される．
・ACE-I/ARBは，ACS患者において血圧が高ければ全例に，血圧が正常もしくは低くても少量から開始し，腎機能・電解質をモニターしながらできる限り増量を目指す．
・左室機能が低下した症候性心不全に対しては，ミネラルコルチコイド受容体拮抗薬のACE-I/ARBへの上乗せ効果を考慮する．
・ACE-Iに忍容性のない場合には，ARBの使用を考慮すべきである．

参考文献

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