Comparison of captopril and enalapril in patients with severe chronic heart failure.
Comparison of captopril and enalapril in patients with severe chronic heart failure.
复制标题
卡托普利和依那普利在严重慢性心力衰竭患者中的比较。
DOI：
10.1056/nejm198610023151402
复制
发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Medina,N
中科院分区：
文献类型：
--
作者：
Packer,M;Lee,WH;Yushak,M;Medina,N
为了评估长作用时间是血管紧张素转换酶抑制剂治疗严重心力衰竭的优势，我们随机分配了42例患者接受短效抑制剂（卡托普利，每天150毫克）或长效抑制剂（依那普利，每天40毫克）治疗一至三个月，同时保持地高辛和利尿剂的联合治疗。治疗组在基线评估时具有相似的血流动力学和临床特征，并且对转化酶抑制的初始反应相似。在长期治疗中，卡托普利和依那普利对全身血压的降低效果相似，但依那普利的降压效果比卡托普利更持久。因此，尽管两组患者在研究期间血液动力学和临床症状均有所改善，但严重的症状性低血压（晕厥和近晕厥）主要见于依那普利治疗的患者。持续低血压也可能是依那普利组肌酸酐清除率下降（P<0.05）和钾潴留（P<0.05）的原因，而卡托普利组没有。我们的结论是，当大剂量、固定剂量的转化酶抑制剂用于治疗严重慢性心力衰竭患者时，长效药物可能产生长期的降压作用，可能损害大脑和肾脏功能，因此在这种情况下，与短效药物相比，长效药物可能有缺点。[J] .中华医学杂志1986；31:847 - 853。]
To evaluate the concept that long duration of action is an advantageous property of angiotensin-converting enzyme inhibitors in the treatment of severe heart failure, we randomly assigned 42 patients to therapy with either a short-acting inhibitor (captopril, 150 mg daily) or a long-acting inhibitor (enalapril, 40 mg daily) for one to three months while concomitant therapy with digoxin and diuretics was kept constant. The treatment groups had similar hemodynamic and clinical characteristics at base-line evaluation and similar initial responses to converting-enzyme inhibition. During long-term therapy, captopril and enalapril produced similar decreases in systemic blood pressure, but the hypotensive effects of enalapril were more prolonged and persistent than those of captopril. Consequently, although the patients in both groups improved hemodynamically and clinically during the study, serious symptomatic hypotension (syncope and near syncope) was seen primarily among those treated with enalapril. Sustained hypotension also probably accounted for the decline in creatinine clearance (P<0.05) and the notable retention of potassium (P<0.05) observed in the patients treated with enalapril but not in those treated with captopril.We conclude that when large, fixed doses of converting-enzyme inhibitors are used in the treatment of patients with severe chronic heart failure, long-acting agents may produce prolonged hypotensive effects that may compromise cerebral and renal function, and thus they may have disadvantages in such cases, as compared with short-acting agents. (N Engl J Med 1986; 315:847–53.)