Galatius S, Wroblewski H, Sørensen V, Haunsø S, Nørgaard T, Kastrup J
Heart Center, Rigshospital, University of Copenhagen, Denmark.
J Card Fail. 1999 Mar;5(1):17-24. doi: 10.1016/s1071-9164(99)90020-9.
Treatment with angiotensin-converting enzyme (ACE) inhibitors in congestive heart failure (CHF) improves cardiac and peripheral hemodynamic function and exercise performance. However, studies on the effects of long-term treatment with an ACE inhibitor on the neurogenic and nonneurogenic regulation and structural microangiopathy of the peripheral microvasculature in CHF are lacking.
We investigated the effect of 12 weeks of treatment with the ACE inhibitor fosinopril on peripheral microvascular function in a double-blind, placebo-controlled study of 12 patients treated with fosinopril and 10 patients treated with placebo. All had moderate CHF. Microvascular blood flow and resistance were calculated after application of the local isotope washout method in relaxed and nonrelaxed calf vascular beds in the supine position and during head-up tilt. Skeletal muscle vascular resistance was reduced in the fosinopril group (46 +/- 6 to 30 +/- 1 mm Hg.mL-1.100 g.min +/- standard error; P < .05) and differed compared with the effect of placebo (P < .05) where no change was seen (37 +/- 11 to 55 +/- 13 mm Hg.mL-1.100 g.min; not significant [NS]). Also, skin minimal vascular resistance was reduced during fosinopril treatment (13 +/- 0.6 to 11 +/- 0.7 mm Hg.mL-1.100 g.min; P < .05) and differed compared with the effect of placebo (P < .05) with absence of change (12 +/- 1.6 to 14 +/- 1.4 mm Hg.mL-1.100 g.min; NS).
These results suggest that long-term ACE inhibitor treatment with fosinopril in patients with CHF improves hemodynamic status to as far as the peripheral microvascular level in both the relaxed and nonrelaxed microcirculation of the lower leg.
在充血性心力衰竭（CHF）中，使用血管紧张素转换酶（ACE）抑制剂进行治疗可改善心脏和外周血流动力学功能以及运动能力。然而，关于ACE抑制剂长期治疗对CHF患者外周微血管神经源性和非神经源性调节以及结构性微血管病变影响的研究尚缺。
在一项双盲、安慰剂对照研究中，我们调查了12周使用ACE抑制剂福辛普利治疗对12例接受福辛普利治疗的患者和10例接受安慰剂治疗的患者外周微血管功能的影响。所有患者均为中度CHF。应用局部同位素洗脱法，在仰卧位和平卧抬腿时，于放松和未放松的小腿血管床中计算微血管血流量和阻力。福辛普利组骨骼肌血管阻力降低（从46±6降至30±1 mmHg·mL-1·100 g·min±标准误；P<.05），与安慰剂组效果相比有差异（P<.05），安慰剂组未见变化（从37±11至55±13 mmHg·mL-1·100 g·min；无显著差异[NS]）。此外，福辛普利治疗期间皮肤最小血管阻力降低（从13±0.6降至11±0.7 mmHg·mL-1·100 g·min；P<.05），与安慰剂组效果相比有差异（P<.05），安慰剂组无变化（从12±1.6至14±1.4 mmHg·mL-1·100 g·min；NS）。
这些结果表明，CHF患者长期使用福辛普利进行ACE抑制剂治疗可改善血流动力学状态，直至小腿放松和未放松微循环的外周微血管水平。
