Deedwania P C
Cardiology Section, Veterans Administration Medical Center, Fresno, Calif 93703.
Arch Intern Med. 1990 Sep;150(9):1798-805.
Angiotensin-converting enzyme inhibitors have had a significant impact on the treatment of congestive heart failure (CHF). Hemodynamic and clinical improvements in patients with severe CHF fostered the use of angiotensin-converting enzyme inhibitors in mild to moderate CHF. Angiotensin-converting enzyme inhibitors produce acute and sustained improvements in ventricular hemodynamics and quality of life. Captopril plus diuretic therapy is an effective alternative to digoxin in patients with mild to moderate CHF. Enalapril maleate and lisinopril have been shown to be effective in moderate to severe CHF when combined with digoxin and diuretics. Captopril and enalapril also improve survival in selected patients; captopril attenuates left ventricular dilatation after myocardial infarction. Although all angiotensin-converting enzyme inhibitors are similar in mechanism of action, pharmacokinetic differences impact their clinical use. Prolonged symptomatic hypotension compromising systemic perfusion and organ function has been reported with longer-acting agents; hypotension is usually short-lived and rarely compromises organ function with shorter-acting agents.
血管紧张素转换酶抑制剂对充血性心力衰竭（CHF）的治疗产生了重大影响。重度CHF患者的血流动力学和临床改善促使血管紧张素转换酶抑制剂在轻至中度CHF中得到应用。血管紧张素转换酶抑制剂可使心室血流动力学和生活质量产生急性和持续性改善。在轻至中度CHF患者中，卡托普利加利尿剂疗法是替代地高辛的有效选择。马来酸依那普利和赖诺普利与地高辛和利尿剂联合使用时，已被证明对中度至重度CHF有效。卡托普利和依那普利还可提高特定患者的生存率；卡托普利可减轻心肌梗死后的左心室扩张。尽管所有血管紧张素转换酶抑制剂的作用机制相似，但药代动力学差异会影响其临床应用。长效制剂曾有报道出现导致全身灌注和器官功能受损的持续性症状性低血压；短效制剂引起的低血压通常持续时间较短，很少会损害器官功能。
