Modesti Pietro Amedeo, Vanni Simone, Gensini Gian Franco
Clinica Medica Generale e Cardiologia Università degli Studi Viale Morgagni, 85 50134 Firenze.
Ital Heart J Suppl. 2003 Aug;4(8):623-34.
Abundant evidence showed that angiotensin-converting enzyme (ACE)-inhibitors reduce long-term cardiovascular morbidity and mortality rates in patients with heart failure and myocardial infarction. More recent studies revealed clinical benefits also in hypertensive patients with comorbidity and lead to an extension of clinical indications. Indeed in patients with severe hypertension differences between drugs are hardly detectable because the risk reduction is mainly related to the control of blood pressure values independent of the type of therapy. Conversely in the presence of comorbid conditions, especially in diabetics, the association of ACE-inhibitors with antihypertensive treatments proved its efficacy in reducing cardiovascular morbidity and mortality so that the role of mechanisms extending beyond blood pressure reduction can be postulated.
大量证据表明，血管紧张素转换酶（ACE）抑制剂可降低心力衰竭和心肌梗死患者的长期心血管发病率和死亡率。最近的研究还揭示了其在合并症高血压患者中的临床益处，并导致临床适应症的扩展。事实上，在重度高血压患者中，很难检测到不同药物之间的差异，因为风险降低主要与血压值的控制有关，而与治疗类型无关。相反，在存在合并症的情况下，尤其是糖尿病患者，ACE抑制剂与抗高血压治疗联合使用已证明其在降低心血管发病率和死亡率方面的疗效，因此可以推测存在超出血压降低的机制作用。
