Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Ziołowa 45-47, PL 40-635 Katowice, Poland.
Pharmacol Rep. 2011;63(3):740-51. doi: 10.1016/s1734-1140(11)70586-2.
Large clinical trials and experimental studies have indicated that not all of the beneficial properties of angiotensin-converting enzyme inhibitors (ACE-Is) can be attributed to the lowering of blood pressure. The aim of this study was to assess doctors' opinions about the importance of the cardioprotective effects of ACE-Is beyond lowering blood pressure. The study participants (685 physicians) filled in a questionnaire testing doctors' knowledge of all of the therapeutic effects of ACE-Is not directly associated with lowering blood pressure and their clinical importance. In addition, each doctor filled in 20 questionnaires for subsequent patients treated with any ACE-I. Fifty-nine percent of the investigated physicians were aware of most of the therapeutic effects of ACE-Is. The most important therapeutic effects for the respondents were the following: reduction of peripheral resistance, inhibition of left ventricle hypertrophy, inhibition of vascular remodeling and atherosclerotic plaque stabilization. The most commonly prescribed ACE-Is were perindopril, lisinopril and chinalapril for inhibition of left ventricular hypertrophy and perindopril, ramipril and chinalapril for inhibition of arterial wall remodeling. The ACE-Is that were used to reduce peripheral vessel resistance included perindopril, lisinopril and trandolapril. Drugs used to stabilize the plaque included perindopril, lisinopril and cilazapril. The therapeutic effects of ACE-Is beyond lowering blood pressure were considered to be valid and important in daily clinical practice for the prevention of cardiovascular diseases and diabetic complications. The attribution of the effects of a particular ACE-I was not always in accordance with evidence-based medicine. The obtained treatment outcomes were attributed to the entire group of ACE-Is.
大型临床试验和实验研究表明，血管紧张素转换酶抑制剂（ACE-Is）的所有有益特性并不仅仅归因于降低血压。本研究旨在评估医生对 ACE-Is 除降低血压以外的心脏保护作用的重要性的看法。研究参与者（685 名医生）填写了一份调查问卷，测试他们对 ACE-Is 所有与降低血压无关的治疗作用及其临床重要性的了解。此外，每位医生还为随后接受任何 ACE-I 治疗的 20 名患者填写了一份问卷。59%的调查医生了解 ACE-Is 的大多数治疗作用。对受访者来说最重要的治疗作用如下：降低外周阻力、抑制左心室肥厚、抑制血管重塑和稳定动脉粥样硬化斑块。最常被处方用于抑制左心室肥厚的 ACE-Is 是培哚普利、赖诺普利和群多普利，用于抑制动脉壁重塑的是培哚普利、雷米普利和群多普利。用于降低外周血管阻力的 ACE-Is 包括培哚普利、赖诺普利和群多普利。用于稳定斑块的药物包括培哚普利、赖诺普利和西拉普利。ACE-Is 除降低血压外的治疗作用在预防心血管疾病和糖尿病并发症的日常临床实践中被认为是有效和重要的。对特定 ACE-I 作用的归因并不总是符合循证医学。所获得的治疗结果归因于整个 ACE-I 类药物。
