Acute and long-term effects of the angiotensin-converting enzyme inhibitor, enalapril, on adrenergic activity and sensitivity during exercise in patients with left ventricular systolic dysfunction.
Acute and long-term effects of the angiotensin-converting enzyme inhibitor, enalapril, on adrenergic activity and sensitivity during exercise in patients with left ventricular systolic dysfunction.
复制标题
血管紧张素转换酶抑制剂依那普利对左心室收缩功能障碍患者运动期间肾上腺素能活性和敏感性的急性和长期影响。
DOI：
10.1016/s0002-8703(97)70104-2
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发表时间：
1997
影响因子：
4.8
通讯作者：
Konstam,MA
中科院分区：
文献类型：
--
作者：
Patten,RD;Kronenberg,MW;Benedict,CR;Udelson,JE;Kinan,D;Stewart,D;Yusuf,S;Smith,JJ;Kilcoyne,L;Dolan,N;Edens,TR;Metherall,J;Konstam,MA
心力衰竭和左心室收缩功能不全患者肾上腺素能活动增加，但肾上腺素能反应性减弱。我们研究了参加左心室功能障碍研究的患者，检查心率（HR）和血浆去甲肾上腺素（PNE）的运动反应。随机分组前研究了87例患者，其中65例在随机分组接受安慰剂或依那普利治疗后1年进行了检查。与预防试验（无症状）患者相比，治疗试验（有症状）患者的静息HR和PNE水平较高，HR增加较少，运动时PNE增加较多。依那普利急性给药仅在预防试验中增加患者的静息心率，但对PNE无显著影响。治疗1年后，预防试验中的患者没有表现出变化。在治疗试验中，安慰剂组表现出更高的峰值PNE和运动PNE增加比依那普利组，其HR反应保持尽管运动PNE减少。我们得出结论：（1）与无症状患者相比，左心室射血分数降低的有症状患者表现出更大的静息和运动肾上腺素能活动，HR反应迟钝;（2）在有症状患者中，依那普利治疗1年后，对肾上腺素能刺激的HR反应增强，支持肾素/血管紧张素和肾上腺素能神经系统之间的相互作用。肾上腺素能张力和反应的正常化可能有助于长期血管紧张素转换酶抑制剂治疗的获益。(Am Heart J 1997; 134：37 - 43.）
Patients with heart failure and left ventricular systolic dysfunction exhibit increased adrenergic activity but blunted adrenergic responsiveness. We studied patients enrolled in the Studies of Left Ventricular Dysfunction, examining exercise responses of heart rate (HR) and plasma norepinephrine (PNE). Eighty-seven patients were studied before randomization; 65 of these were examined 1 year after randomization to placebo or enalapril. Compared with prevention trial (asymptomatic) patients, patients in the treatment trial (symptomatic) had higher resting HR and PNE levels and less increase in HR with a greater increase in PNE with exercise. Acute administration of enalapril increased the resting HR in patients in the prevention trial only but had no significant effect on PNE. After 1 year of therapy, patients in the prevention trial exhibited no change. Within the treatment trial, the placebo group displayed both a higher peak PNE and increase in PNE with exercise than did the enalapril group, whose HR response was maintained in spite of a reduction of exercise PNE. We conclude that (1) compared with asymptomatic patients, symptomatic patients with reduced left ventricular ejection fraction manifest greater resting and exercise adrenergic activity, with blunted HR response; and (2) in symptomatic patients, 1 year of enalapril treatment effected an augmented HR response to adrenergic stimulation, supporting an interaction between the renin/angiotensin and adrenergic nervous systems. Normalization of adrenergic tone and response likely contributes to the benefits of long-term angiotensin-converting enzyme inhibitor therapy. (Am Heart J 1997;134: 37-43.)