关于心力衰竭中“高”剂量血管紧张素转换酶抑制，ATLAS研究到底告诉了我们什么？

What does ATLAS really tell us about "high" dose angiotensin-converting enzyme inhibition in heart failure?

作者信息

Nicklas J M, Cohn J N, Pitt B

机构信息

Department of Medicine, University of Michigan Medical Center, Ann Arbor, USA.

出版信息

J Card Fail. 2000 Jun;6(2):165-8.

PMID:10908091

Abstract

The Assessment of Treatment with Lisinopril and Survival (ATLAS) results have been widely quoted by proponents advocating the use of "high" doses of angiotensin-converting enzyme (ACE) inhibitors for the treatment of heart failure. In ATLAS, however, the relative benefits of "high" versus "low" dose ACE inhibition were small. Intermediate doses of ACE inhibitors proven effective in previous placebo-controlled trials provide benefit that appears likely to equal or exceed the benefit from "high" dose ACE inhibition. Therefore, we recommend that physicians continue to prescribe ACE inhibitors for patients with heart failure based on the target doses used in the placebo-controlled trials and not on the "high" dose target used in ATLAS.

摘要

赖诺普利治疗与生存评估（ATLAS）研究结果被主张使用“高”剂量血管紧张素转换酶（ACE）抑制剂治疗心力衰竭的支持者广泛引用。然而，在ATLAS研究中，“高”剂量与“低”剂量ACE抑制的相对获益较小。在先前的安慰剂对照试验中已证实有效的中等剂量ACE抑制剂所带来的获益似乎可能等于或超过“高”剂量ACE抑制的获益。因此，我们建议医生继续根据安慰剂对照试验中使用的目标剂量为心力衰竭患者开具ACE抑制剂，而不是依据ATLAS研究中使用的“高”剂量目标。