摘要
目的:探讨2种血管紧张素转化酶抑制剂(ACEI)西拉普利、卡托普利对心力衰竭患者血压的影响及某些生化指标变化。方法:本组210例NYHA心功能Ⅱ、Ⅲ、Ⅳ级的充血性心力衰竭(CHF)患者随机、单盲分为西拉普利组、卡托普利组和安慰剂组(各70例),比较首剂服药后平均动脉压(MAP)、2周后平均血压和心率、血浆肾素、血管紧张素、醛固酮、肌酐及钾、钠值变化。结果:卡托普利首剂服药后1h达最大降压效果,持续6～10h,西拉普利作用缓和,首剂服药后2h达最大降压效果,可维持18～24h,对血压较高者,可降低收缩压10～25mmHg,而对于血压正常,则降低血压的程度较小(5～10mmHg)。卡托普利在大于70岁老年人中,血压容易过低,尤其是首剂多见,以直立性低血压多见,西拉普利组未发现。2组均可降低血管紧张素水平,无统计学差异。西拉普利组未明显增加血钾浓度,对肾功能无明显损害,卡托普利有轻度增高血钾作用。结论:在心力衰竭患者中,特别对高血压患者,西拉普利有良好的降压作用,对血压正常的患者及老年人,西拉普利作为心力衰竭的基本治疗药物,是安全有效的。
Objective: To investigate the influence of 2 types of angiotensin converting enzyme inhibitors (ACEI), i. e. Cilaza-
pril and Captopril on blood pressure of congestive heart failure (CHF) patients as well as the changes of biochemical markers. Meth-
ods: 210 CHF patients of NYHA class Ⅱ, Ⅲ and Ⅳ were randomly divided into Cilazapril Group, Captopril Group and Placebo Group
(70 each group) and compared in first--dose MAP and in changes of the value of average blood pressure and heart rate, blood plasma
rennin,angiotensin, aldosterone, creatinine, Potassium and Sodium. Results: the blood pressure reducing effect reached the maxi-
mum an hour after first dose of Captopril was taken, it lasted for 6～20 hours. Whereas Cilazapril worked mildly, the blood pressure
reducing effect came to the maximum 2 hours after the first dose and lasted for 18～24 hours. For the persons with a higher blood pres-
sure, it can bring down their systolic pressure by 10～25mmHg, while for those with a normal blood pressure, it doesn't show marked
effect in reducing their blood pressure (by 5～10mmHg). To some extent, it is risky for elder people of over 70 years old to take Capto-
pril as the medicine can result in an extremely low blood pressure commonly seen in first dose and most of the cases are of orthostatic
hypotension. Whereas in Cilazapril Group, no such unwanted effect was seen. Both Cilazapril Group and Captopril Group can reduce
the level of angiotensin without statistic difference. Cilazapril Group didn't see any remarkable increase of Potassium concentration in
the blood and damage on kidney function. Captopril can slightly increase Potassium concentration in the blood. Conclusions: For
heart failure patients, especially hypertension patients, Cilazapril shows a good effect in reducing their blood pressure; for the patients
with a normal blood pressure and the elders, it is a safe and effective medicine in treating heart failure.
出处
《中国医药导刊》
2004年第3期200-202,共3页
Chinese Journal of Medicinal Guide
