Ball S G
Dept. of Cardiovascular Studies, University of Leeds, England.
Clin Physiol Biochem. 1992;9(3):98-104.
Angiotensin converting enzyme inhibitors are now widely used in the treatment of hypertension and heart failure. They are clearly as effective as other conventional antihypertensive agents in reducing blood pressure and combined with diuretics seem likely to transform current management of chronic heart failure. Myocardial infarction remains the major cause of death in patients with raised blood pressure and current studies should establish whether the attractive features of ACE inhibitors translate into reduction in the rate of infarction or its consequences. Similarly, whilst symptomatic benefit undoubtedly accrues from their use in heart failure it is less clear that they can prolong life particularly when used in the immediate setting of a myocardial infarction. Again a number of ongoing major trials are set to establish whether these drugs reduce death in patients with chronic heart failure (V-HeFT II, SOLVD) and in patients immediately after myocardial infarction (CONSENSUS II, SAVE,. AIRE, GISSI III and ISIS IV). The physician has a wide choice of ACE inhibitors with different pharmacological profiles for clinical use.
血管紧张素转换酶抑制剂目前广泛应用于高血压和心力衰竭的治疗。在降低血压方面，它们显然与其他传统抗高血压药物一样有效，并且与利尿剂联合使用似乎可能改变目前慢性心力衰竭的治疗方法。心肌梗死仍然是血压升高患者的主要死因，目前的研究应该确定血管紧张素转换酶抑制剂的诱人特性是否能转化为梗死发生率或其后果的降低。同样，虽然它们用于心力衰竭无疑能带来症状改善，但它们是否能延长生命尚不清楚，尤其是在心肌梗死急性期使用时。同样，一些正在进行的大型试验将确定这些药物是否能降低慢性心力衰竭患者（V-HeFT II、SOLVD）以及心肌梗死后即刻患者（CONSENSUS II、SAVE、AIRE、GISSI III和ISIS IV）的死亡率。临床使用时，医生有多种具有不同药理学特性的血管紧张素转换酶抑制剂可供选择。
