Ertl G, Gaudron P, Eilles C
Medizinische Klinik, Universität Würzburg.
Herz. 1990 Jun;15(3):158-63.
Challenge to a new therapeutic principle to treat heart failure is to ameliorate or eliminate symptoms, decelerate progression of the disease and reduce mortality. However, to begin, one would request improvement of objective hemodynamic parameters. Angiotensin converting enzyme (ACE) inhibitors may have acute and chronic, global and regional effects. ACE inhibitors acutely and chronically reduce pre- and afterload without reflex tachycardia. They lower myocardial oxygen consumption and improve the relation of coronary blood flow to myocardial oxygen consumption. Cerebral and renal blood flow generally are beneficially influenced if the blood pressure is not lowered too much. Left ventricular dilatation following extensive myocardial infarction which is prognostically unfavourable, may be retarded or prevented by ACE-inhibitors. It is not yet clear whether mortality may thus be reduced as in patients with severe heart failure. Large multicenter studies currently address this question. It is unclear as well whether the effects of ACE-inhibitors are exclusively due to a reduction of circulating angiotensin II. Most likely, interference is of major importance with local renin-angiotensin systems, other hormone systems and the central and peripheral nervous system.
对治疗心力衰竭的新治疗原则的挑战在于改善或消除症状、减缓疾病进展并降低死亡率。然而，首先，人们会要求改善客观的血流动力学参数。血管紧张素转换酶（ACE）抑制剂可能具有急性和慢性、整体和局部的作用。ACE抑制剂可急性和慢性地降低前负荷和后负荷，而无反射性心动过速。它们降低心肌耗氧量，并改善冠状动脉血流与心肌耗氧量的关系。如果血压不过度降低，脑和肾血流通常会受到有益影响。广泛心肌梗死后出现的左心室扩张预后不良，ACE抑制剂可能会延缓或预防这种情况。目前尚不清楚这是否会像在重度心力衰竭患者中那样降低死亡率。大型多中心研究目前正在解决这个问题。同样不清楚的是，ACE抑制剂的作用是否完全归因于循环血管紧张素II的减少。很可能，对局部肾素-血管紧张素系统、其他激素系统以及中枢和外周神经系统的干扰起主要作用。
