Gring Christian N, Francis Gary S
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Am Coll Cardiol. 2004 Nov 2;44(9):1841-6. doi: 10.1016/j.jacc.2004.07.044.
Multiple trials over the past several years have examined indications for angiotensin receptor blockers (ARBs) in the treatment of left ventricular dysfunction, both acutely after myocardial infarction and in chronic heart failure. Yet despite these data, there is still confusion regarding the efficacy of ARBs as monotherapy in these patient populations, as well as the specific indications for combination ARB/angiotensin-converting enzyme (ACE) inhibitor therapy. We examine the key differences among the trials-including the ACE inhibitor dose, the ARB and its dose, blood pressure reduction, and patient populations-to present our perspective on ARB use, alone or in combination with ACE inhibitors, in patients with chronic heart failure and post-myocardial infarction left ventricular dysfunction. We conclude that ACE inhibitors remain the first-line therapy for left ventricular dysfunction. Angiotensin receptor blockers should be reserved for monotherapy in ACE intolerant patients and for combination therapy in symptomatic class II/III patients with chronic heart failure.
在过去几年中，多项试验研究了血管紧张素受体阻滞剂（ARB）在治疗左心室功能障碍方面的适应证，包括心肌梗死后急性治疗以及慢性心力衰竭治疗。然而，尽管有这些数据，但对于ARB在这些患者群体中作为单一疗法的疗效，以及ARB/血管紧张素转换酶（ACE）抑制剂联合治疗的具体适应证，仍存在困惑。我们研究了各项试验之间的关键差异，包括ACE抑制剂剂量、ARB及其剂量、血压降低情况以及患者群体，以阐述我们对于ARB单独使用或与ACE抑制剂联合使用，在慢性心力衰竭和心肌梗死后左心室功能障碍患者中的应用观点。我们得出结论，ACE抑制剂仍然是左心室功能障碍的一线治疗药物。血管紧张素受体阻滞剂应保留用于不耐受ACE的患者的单一疗法，以及有症状的II/III级慢性心力衰竭患者的联合疗法。
