Renal hemodynamic consequences of angiotensin-converting enzyme inhibition in congestive heart failure.
Renal hemodynamic consequences of angiotensin-converting enzyme inhibition in congestive heart failure.
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充血性心力衰竭中血管紧张素转换酶抑制的肾血流动力学后果。
DOI：
10.1001/archinte.1989.00390030125024
复制
发表时间：
1989
影响因子：
--
通讯作者：
W. Suki
中科院分区：
文献类型：
--
作者：
W. Suki
血管紧张素转换酶（ACE）抑制剂在心力衰竭的管理中是有益的。在一些心力衰竭患者的研究中，使用长效药物马来酸依那普利治疗的患者比使用短效药物卡托普利治疗的患者更常发生肾功能下降。发生肾功能下降的患者有许多诱发激素和血流动力学因素。在一份报告中，这些因素包括持续的初始血压下降、较低的心输出量以及相对较高的固定剂量的依那普利，导致肾损伤。在第二项研究中，肾功能下降在全身动脉压较低的患者中最为严重，这些患者的肾小球滤过可能依赖于血管紧张素II。在第三项研究中，血管内容量不足和激活的肾素-血管紧张素系统导致肾功能下降。ACE抑制剂降低血浆和组织中的血管紧张素II水平可降低全身血管阻力和传出小动脉张力，这往往会降低肾小球滤过率。如果心输出量代偿性增加不足或存在既存肾损害或血容量不足，肾功能将恶化。长效ACE抑制剂延长了传出小动脉张力的下降，并可能损害心肌对儿茶酚胺的反应。在肾功能恶化的患者中使用短效药物可能是首选。
Angiotensin-converting enzyme (ACE) inhibitors are of benefit in the management of heart failure. In some studies in patients with heart failure, a decline in renal function occurred more frequently in patients treated with enalapril maleate, a longer-acting agent, than in those treated with captopril, a shorter-acting drug. Patients experiencing a decline in renal function had a number of predisposing hormonal and hemodynamic factors. In one report, these factors included an initial fall in blood pressure that was sustained, lower cardiac output, and a relatively high fixed dose of enalapril that contributed to renal impairment. In a second study, the decline in renal function was most severe in patients with a lower systemic arterial pressure in whom glomerular filtration may have been dependent on angiotensin II. In a third study, intravascular volume depletion and an activated renin-angiotensin system led to reduced renal function. Reduction of angiotensin II level in plasma and tissues by ACE inhibitors decreases systemic vascular resistance and efferent arteriolar tone, which tends to decrease glomerular filtration rate. If compensatory increases in cardiac output are inadequate or preexisting renal impairment or volume depletion is present, renal function will deteriorate. Long-acting ACE inhibitors prolong the decreased efferent arteriolar tone and may compromise cardiac muscle response to catecholamines. The use of shorter-acting agents in patients who exhibit deterioration in renal function may be preferable.
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
发表时间：
1986
期刊：
The New England journal of medicine
影响因子：
--
作者：
Packer,M;Lee,WH;Yushak,M;Medina,N
通讯作者：
Medina,N
影响因子：
39.2
作者：
PACKER, M;WAI, HL;KESSLER, PD
通讯作者：
KESSLER, PD
血管紧张素 II 的肾小球作用。
DOI：
10.1016/0002-9343(84)90882-9
发表时间：
1984
期刊：
The American journal of medicine
影响因子：
--
作者：
Ichikawa,I;Brenner,BM
通讯作者：
Brenner,BM