Cardiovasc Drugs Ther. 2001 Nov;15(6):501-6. doi: 10.1023/a:1013763603926.
Angiotensin converting enzyme (ACE) inhibitors reduce morbidity and mortality in patients with heart failure and are a first-line therapy for chronic heart failure. However, the first-dose may be associated with asymptomatic or symptomatic hypotension. In previous small series with different ACE inhibitors, different blood pressure responses have been reported. We defined hypotension as a fall in mean blood pressure > or = 20 mm Hg and an absolute value of systolic blood pressure < or = 90 mm Hg and diastolic blood pressure <60 mm Hg. We studied the evolution of mean, systolic and diastolic blood pressure after initiation of perindopril and captopril treatments in a multicentre, double-blind, randomised, comparative, prospective study. One hundred seventy-six patients, mean age 64.9+/-12.1 years, 116 men, with symptomatic heart failure, NYHA class II-IV, and a left ventricular ejection fraction <40%, were randomised to receive a single dose of captopril 6.25 mg (n = 85) or perindopril 2 mg, (n = 91). Systolic and diastolic blood pressure were recorded with Dinamap every 15 minutes during a baseline period of 2 hours, every 30 minutes from 2 to 7 hours and at 8 hours after the drug administration. Baseline characteristics of both groups were similar (demography, heart failure aetiology, NYHA class and blood pressure). Throughout the study there were 23 asymptomatic episodes of hypotension in the captopril group and 6 in the perindopril group (p = 0.039). One patient in the captopril group had symptomatic episodes. Mean blood pressure falls were significantly higher in the captopril versus perindopril group at 60 minutes (-4.6 mm Hg vs+0.7 mm Hg; p=0.004), 75 minutes (-4.4 mm Hg vs -1.1 mm Hg; p = 0.042), and 180 minutes (-3.4 mm Hg vs +0.0 mm Hg; p= 0.042). When elderly patients (> or =70 years) were considered the same pattern of response was found. In summary, first-dose hypotension is not negligible on initiation of therapy with ACE inhibitors in heart failure patients with low ejection fraction. Perindopril results in significantly less reduction in blood pressure and a lower incidence of symptomatic or asymptomatic hypotensive episodes and allows a safer start of therapy than captopril in heart failure patients.
血管紧张素转换酶（ACE）抑制剂可降低心力衰竭患者的发病率和死亡率，是慢性心力衰竭的一线治疗药物。然而，首剂用药可能会导致无症状或有症状的低血压。在先前使用不同ACE抑制剂的小样本研究中，曾报道过不同的血压反应。我们将低血压定义为平均血压下降≥20 mmHg，收缩压绝对值≤90 mmHg且舒张压<60 mmHg。在一项多中心、双盲、随机、对照、前瞻性研究中，我们研究了培哚普利和卡托普利治疗开始后平均血压、收缩压和舒张压的变化情况。176例患者，平均年龄64.9±12.1岁，男性116例，有症状性心力衰竭，纽约心脏协会（NYHA）心功能分级为II - IV级，左心室射血分数<40%，被随机分为两组，分别接受单剂量卡托普利6.25 mg（n = 85）或培哚普利2 mg（n = 91）。在2小时的基线期内，每15分钟用电子血压计记录收缩压和舒张压，用药后2至7小时每30分钟记录一次，8小时时再记录一次。两组的基线特征相似（人口统计学、心力衰竭病因、NYHA分级和血压）。在整个研究过程中，卡托普利组有23次无症状性低血压发作，培哚普利组有6次（p = 0.039）。卡托普利组有1例患者出现有症状性发作。在60分钟时，卡托普利组的平均血压下降幅度显著高于培哚普利组（-4.6 mmHg对+0.7 mmHg；p = 0.004），75分钟时（-4.4 mmHg对-1.1 mmHg；p = = 0.042），180分钟时（-3.4 mmHg对+0.0 mmHg；p = 0.042）。在考虑老年患者（≥70岁）时，发现了相同的反应模式。总之，在射血分数低的心力衰竭患者中开始使用ACE抑制剂治疗时，首剂低血压不容忽视。与卡托普利相比，培哚普利导致的血压下降明显较少，有症状或无症状性低血压发作的发生率较低，在心力衰竭患者中能使治疗开始得更安全。
