Efficacy of captopril in low-renin congestive heart failure: importance of sustained reactive hyperreninemia in distinguishing responders from nonresponders.
Efficacy of captopril in low-renin congestive heart failure: importance of sustained reactive hyperreninemia in distinguishing responders from nonresponders.
复制标题
卡托普利对低肾素充血性心力衰竭的疗效：持续反应性高肾素血症在区分反应者和无反应者中的重要性。
DOI：
10.1016/s0002-9149(84)80206-4
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
M. Yushak
中科院分区：
文献类型：
--
作者：
M. Packer;N. Medina;M. Yushak
为了确定转换酶抑制剂对低肾素充血性心力衰竭（CHF）患者的疗效，对26例治疗前血浆肾素活性（PRA）<2 ng/ml/h的慢性重度CHF患者进行了长期血流动力学和临床反应评价。经过2 ~ 8周的持续治疗，14例患者（54%）显示出长期血流动力学获益，其中13例（50%）临床改善至少1个纽约心脏协会功能分级。为了区分应答者和无应答者，根据是否存在持续反应性高肾素血症（慢性治疗期间PRA>4 ng/ml/h）对患者进行分组。14例患者经开搏通治疗2 ~ 8周后出现反应性高肾素血症。他们的心脏指数增加了0.33升/分钟/平方米（p <0.01），左心室充盈压降低了12.6毫米汞柱（p <0.001），平均右心房压降低了4.9毫米汞柱（p <0.001），全身血管阻力降低了529达因·厘米-5（p <0.001）。这14例患者中有12例患者临床改善。另外12例患者PRA无反应性增加，这些患者在接受卡托普利治疗2 - 8周后，任何血流动力学变量均无显著改善; 12例患者中仅1例临床改善（两组间p <0.001）。两组在治疗前人口统计学、血流动力学和激素变量方面相似。因此，许多与低PRA相关的重度慢性CHF患者在卡托普利治疗期间改善，这些患者可以通过长期治疗期间反应性高肾素血症的发生与无应答者区分开来。
To determine the efficacy of converting-enzyme inhibition in patients with low-renin congestive heart failure (CHF), the long-term hemodynamic and clinical responses to captopril were evaluated in 26 consecutive patients with severe, chronic CHF whose pretreatment plasma renin activity (PRA) was <2 ng/ml/hour. After 2 to 8 weeks of continuous treatment with captopril, 14 patients (54%) showed long-term hemodynamic benefits, of whom 13 (50%) improved clinically by at least 1 New York Heart Association functional class. To distinguish responders from nonresponders, patients were grouped based on the presence or absence of sustained reactive hyperreninemia (PRA during chronic therapy >4 ng/ml/hour). After 2 to 8 weeks of therapy with captopril, 14 patients had sustained reactive hyperreninemia. Their cardiac index increased by 0.33 liters/min/m2(p <0.01), left ventricular filling pressure decreased by 12.6 mm Hg (p <0.001), mean right atrial pressure decreased by 4.9 mm Hg (p <0.001) and systemic vascular resistance decreased by 529 dyne s cm−5(p <0.001). Twelve of these 14 patients patients improved clinically. Twelve other patients had no reactive increase in PRA, and these patients showed no significant improvement in any hemodynamic variable after 2 to 8 weeks of treatment with captopril; only 1 of the 12 patients improved clinically (p <0.001 between groups). The 2 groups were otherwise similar with regard to pretreatment demographic, hemodynamic and hormonal variables. Thus, many patients with severe, chronic CHF associated with a low PRA improve during therapy with captopril, and these patients can be distinguished from nonresponders by the occurrence of reactive hyperreninemia during long-term treatment.
血管紧张素阻断的抗高血压作用：萨拉拉辛与卡托普利。
影响因子：
12.3
作者：
Baker,KM;Johns,DW;VaughanJr,ED;Ayers,CR;Carey,RM
通讯作者：
Carey,RM