Inhibiteurs de l'enzyme de conversion de l'angiotensine ou antagonistes des récepteurs de l'angiotensine 2 en pathologie cardio-vasculaire et néphrologique : que nous dit l'Evidence Based Medicine?
Krzesinski, Jean-Marie; Montrieux, Christian; Scheen, André
2006 • In Revue Médicale de Liège, 61 (5-6), p. 414-422
Evidence based medicine; Angiotensin II receptor blocker; Angiotensin converting enzyme inhibitors; Cardiovascular disease; Renal disease; Médecine factuelle; Antagonistes des récepteurs de l'angiotensine; Inhibiteurs de l'enzyme de conversion de l'angiotensine; Maladies cardio-vasculaires; Néphropathie
Abstract :
[en] Inhibitors of the renin-angiotensin system have proved their great value in secondary prevention trials for cardiovascular or renal complications. In favour of the preferred use of angiotensin receptor antagonists stand their excellent tolerance and the possible therapeutic escape seen with angiotensin converting enzyme inhibitors. For the preferential use of the latter, the arguments are the absence of a real proof of any superiority of the angiotensin receptor blockers and their higher cost. The wisdom is to initially use angiotensin converting enzyme inhibitors in secondary prevention excepted when they are not well tolerated. The large ONTARGET cardiovascular prevention trial should help solve this controversy. [fr] Les inhibiteurs du système rénine-angiotensine ont gagné leur lettre de noblesse pour la prévention secondaire des complications cardio-vasculaires et néphrologiques. Les partisans
des antagonistes des récepteurs AT1 de l'angiotensine II (sartans) tirent leurs arguments du possible échappement thérapeutique sous inhibiteur de l'enzyme de conversion de l’angiotensine et de l'excellente tolérance des sartans. Ceux soutenant l'usage en première ligne des inhibiteurs de l'enzyme de conversion mettent en avant le peu de bénéfice supplémentaire apporté par les sartans, sauf lorsque les inhibiteurs de l'enzyme de conversion ne sont pas tolérés. Le coût supérieur des médicaments inhibant les récepteurs AT1 de l'angiotensine II joue actuellement en leur défaveur dans ce débat.
Bientôt seront connus les résultats d'une grande étude de prévention cardio-vasculaire comparant directement les deux classes thérapeutiques (étude ONTARGET). Les idées devraient alors être plus claires.
Krzesinski, Jean-Marie ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
Montrieux, Christian ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Language :
French
Title :
Inhibiteurs de l'enzyme de conversion de l'angiotensine ou antagonistes des récepteurs de l'angiotensine 2 en pathologie cardio-vasculaire et néphrologique : que nous dit l'Evidence Based Medicine?
Alternative titles :
[fr] Angiotensin converting enzyme inhibitors or angiotensin II receptor blocker in cardiovascular and renal pathology in 2006 : what does EBM teach us?
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