<International Circulation>:  Regarding medical therapy for heart failure， why do we use ACE-inhibitors and blood pressure medications regardless of whether or not they have hypertension?

　　《国际循环》：就心力衰竭药物治疗而言，为什么不论患者是否伴有高血压，我们都应用ACEI类药物以及降压药？
　　Dr Konstam:  Hypertension is probably the single highest most prevalent attributable risk for patients with heart failure. That does not necessarily mean that they had hypertension at the time of presentation with heart failure but it is a major causal factor. The reason that we give ACE-inhibitors to heart failure patients is because they reduce mortality and there are lots of trials that show it， but it has nothing directly to do with hypertension. It has to do with neurohormonal antagonism. Neurohormones are upregulated in heart failure and we have known that for thirty or forty years. One of the hormone systems that is upregulated is the renin-angiotensin system and another is the adrenergic nervous system. The pharmacological therapeutic advances we have had over the past twenty or thirty years have overwhelming been by neurohormonal antagonism because neurohormones drive the progression of heart failure independent of blood pressure.

为何应用ACEI类药物治疗心力衰竭

    用ACEI类药物治疗心力衰竭主要是因其能够降低患者的死亡率。心力衰竭时神经激素（肾素-血管紧张素系统和肾上腺素能神经系统）水平上调，ACEI类药物对心力衰竭的有益效应可能并不是源于ACEI类药物的降压作用，而是因为其能够拮抗神经激素的作用。

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