Effects of enalapril in heart failure: a double blind study of effects on exercise performance, renal function, hormones, and metabolic state.
Effects of enalapril in heart failure: a double blind study of effects on exercise performance, renal function, hormones, and metabolic state.
复制标题
依那普利对心力衰竭的影响：对运动表现、肾功能、激素和代谢状态影响的双盲研究。
作者：
J. Cleland;H. Dargie;S. Ball;G. Gillen;G. P. Hodsman;J. Morton;B. W. East;I. Robertson;I. Ford;J. Robertson
几项研究表明，在接受利尿剂治疗的心力衰竭患者中，引入血管紧张素转换酶抑制剂后，症状和血液动力学改善。新的口服有效的长效血管紧张素转换酶抑制剂依那普利对症状、运动能力、心脏功能、心律失常、激素、电解质、身体成分和肾功能的伴随长期影响已在安慰剂对照的双盲交叉试验中进一步评估，治疗期为8周。对20例纽约心脏协会功能分级为II至IV级心力衰竭的患者进行了研究，这些患者在地高辛和利尿剂治疗后临床稳定。除了引入依那普利，在研究期间常规治疗没有改变;没有注意到顺序或阶段效应。依那普利治疗显著改善了功能分级、呼吸困难症状评分和运动耐量。依那普利治疗后收缩压显著降低。超声心动图评估表明左心室尺寸减小，收缩时间间期改善。依那普利治疗后，血管紧张素II的血浆浓度降低，活性肾素升高;醛固酮、加压素和去甲肾上腺素的血浆浓度下降。依那普利组血清钾和血清镁显著升高。肾小球滤过率测定同位素技术和肌酐清除率下降依那普利，而血清尿素和肌酐上升，有效肾血浆流量增加。体重和全身钠无变化，表明总体无利尿作用。尽管全身钾的增加与治疗前血浆肾素直接相关（r = 0.5），但在统计学上无显著性差异。依那普利改善症状，运动能力，血浆去甲肾上腺素下降，血清钾升高与室性期外收缩的频率在动态监测中记录的下降一致。不良反应少。在心力衰竭患者中，依那普利对症状和功能能力有有益的影响。依那普利降低肾小球滤过率可能对早期心力衰竭不利。
Several studies have shown symptomatic and haemodynamic improvement after the introduction of angiotensin converting enzyme inhibitors in patients with heart failure treated with diuretics. The concomitant long term effects of the new orally effective long acting angiotensin converting enzyme inhibitor, enalapril, on symptoms, exercise performance, cardiac function, arrhythmias, hormones, electrolytes, body composition, and renal function have been further assessed in a placebo controlled double blind cross over trial with treatment periods of eight weeks. Twenty patients with New York Heart Association functional class II to IV heart failure who were clinically stable on digoxin and diuretic therapy were studied. Apart from the introduction of enalapril, regular treatment was not changed over the study period; no order or period effects were noted. Enalapril treatment significantly improved functional class, symptom score for breathlessness, and exercise tolerance. Systolic blood pressure was significantly lower on enalapril treatment. Echocardiographic assessment indicated a reduction in left ventricular dimensions and an improvement in systolic time intervals. In response to enalapril, the plasma concentration of angiotensin II was reduced and that of active renin rose; plasma concentrations of aldosterone, vasopressin, and noradrenaline fell. There were significant increases in serum potassium and serum magnesium on enalapril. Glomerular filtration rate measured both by isotopic techniques and by creatinine clearance declined on enalapril while serum urea and creatinine rose and effective renal plasma flow increased. Body weight and total body sodium were unchanged indicating that there was no overall diuresis. There was a statistically insignificant rise in total body potassium, though the increase was related directly to pretreatment plasma renin (r = 0.5). On enalapril the improvement in symptoms, exercise performance, fall in plasma noradrenaline, and rise in serum potassium coincided with a decline in the frequency of ventricular extrasystoles recorded during ambulatory monitoring. Adverse effects were few. In patients with heart failure, enalapril had a beneficial effect on symptoms and functional capacity. The decline in glomerular filtration rate on enalapril may not be beneficial in early heart failure.
利尿剂引起的心室异位活动。
DOI：
10.1016/0002-9343(81)90530-1
发表时间：
1981
期刊：
The American journal of medicine
影响因子：
--
作者：
Holland,OB;Nixon,JV;Kuhnert,L
通讯作者：
Kuhnert,L