Spinar J, Vítovec J
Department of Internal Medicine II, St Ann's Teaching Hospital, Brno, Czech Republic.
Int J Cardiol. 2005 Apr 20;100(2):199-206. doi: 10.1016/j.ijcard.2004.05.077.
To evaluate the effect of ACE inhibitor moexipril if added to combination therapy in patient with poorly controlled hypertension.
Four hundred twenty patients with hypertension treated with monotherapy or two dug combination without an ACE inhibitor or AII antagonist and with blood pressure >/=140/90 mm Hg.
Single-blind, multicenter, open, with a double-blind echocardiographic examination.
Basic cardiological examination including echocardiography was performed before including into the study. If the patient fulfilled inclusion criteria, ACE inhibitor moexipril was added to the therapy and uptitrated according to BP values. BP measuring, clinical examination, and basic laboratory were performed every month, echocardiography was repeated after 6 months.
Sitting BP decreased from 161.43+/-12.84/96.72+/-7.74 mm Hg to 135.87+/-9.98/82.36+/-5.83 mm Hg (p<0.0001), heart rate from 73.08+/-9.87 to 69.80+/-7.91 (p<0.0001). Three hundred forty patients (81%) had BPd <90 mm Hg after 6 months. Left ventricle mass decreased from 263.24+/-94.69 to 246.71+/-89.08 g (p<0.0001), left atrium decreased from 39.78+/-5.40 to 38.89+/-4.98 mm (p<0.0001), and E/A ratio increased from 0.91+/-0.28 to 0.94+/-0.27 (p<0.0005). Plasma cholesterol level decreased from 5.67+/-0.87 to 5.44+/-0.68 mmol/l (p<0.0001) and plasma triglycerides decreased from 1.92+/-1.07 to 1.78+/-0.80 mmol/l (p<0.001). A greater effect on blood pressure reduction was observed in combination ACE-I+diuretics than in combination ACE-I+betablocker or ACE-I+Ca blocker (statistically borderline). A statistically greater effect on left ventricle mass was observed if moexipril was added to a diuretic than to Ca blocker (p=0.02) or betablocker (p=0.04).
ACE inhibitor moexipril added to combination therapy of hypertension had similar effect on blood pressure reduction and left ventricle mass as in monotherapy trials. The most effective combination is ACE ihibitor+thiazide diuretic. A very small number of adverse events was observed; cough was reported in 2.14% of patients. Decreased heart rate and improvement in lipid parameters were observed in the whole group.
评估在血压控制不佳的高血压患者联合治疗中加用血管紧张素转换酶（ACE）抑制剂莫昔普利的效果。
420例高血压患者，接受单一疗法或不含ACE抑制剂或血管紧张素II拮抗剂的两种药物联合治疗，血压≥140/90 mmHg。
单盲、多中心、开放试验，伴有双盲超声心动图检查。
在纳入研究前进行包括超声心动图在内的基础心脏病学检查。若患者符合纳入标准，则在治疗中加用ACE抑制剂莫昔普利，并根据血压值上调剂量。每月进行血压测量、临床检查和基础实验室检查，6个月后重复超声心动图检查。
坐位血压从161.43±12.84/96.72±7.74 mmHg降至135.87±9.98/82.36±5.83 mmHg（p<0.0001），心率从73.08±9.87降至69.80±7.91（p<0.0001）。6个月后，340例患者（81%）舒张压<90 mmHg。左心室质量从263.24±94.69 g降至246.71±89.08 g（p<0.0001），左心房从39.78±5.40 mm降至38.89±4.98 mm（p<0.0001），E/A比值从0.91±0.28增至0.94±0.27（p<0.0005）。血浆胆固醇水平从5.67±0.87 mmol/L降至5.44±0.68 mmol/L（p<0.0001），血浆甘油三酯从1.92±1.07 mmol/L降至1.78±0.80 mmol/L（p<0.001）。观察到ACE-I与利尿剂联合使用时降压效果优于ACE-I与β受体阻滞剂或ACE-I与钙通道阻滞剂联合使用（统计学上接近临界值）。若将莫昔普利添加到利尿剂中，对左心室质量的影响在统计学上大于添加到钙通道阻滞剂（p=0.02）或β受体阻滞剂（p=0.04）。
在高血压联合治疗中加用ACE抑制剂莫昔普利，在降低血压和左心室质量方面与单一疗法试验效果相似。最有效的联合用药是ACE抑制剂+噻嗪类利尿剂。观察到的不良事件数量极少；2.14%的患者报告有咳嗽。全组患者心率下降，血脂参数改善。
