Anderson A, Morgan T
Repatriation General Hospital, Department of Physiology, University of Melbourne, Parkville, Australia.
Nephron. 1990;55 Suppl 1:70-2. doi: 10.1159/000186039.
While monotherapy sometimes controls blood pressure (BP), it is often essential to add a second drug for adequate control. This study examined in a factorial fashion the interaction of enalapril with some commonly used antihypertensive therapies. There were between 10 and 16 patients in each study, and the patients had responded in part to the two drugs used. Enalapril and sodium restriction lowered BP 12 +/- 3/11 +/- 2 and 4 +/- 2/3 +/- 1 mm Hg, respectively. The effects of the two therapies were additive, and there was no interaction. Enalapril and hydrochlorothiazide lowered BP 11 +/- 3/8 +/- 3 and 8 +/- 2/6 +/- 2 mm Hg, respectively. The effect of the two drugs together indicated a positive interaction of 4 +/- 2/3 +/- 1 mm Hg (p less than 0.05). Enalapril and nifedipine both lowered BP (10 +/- 2/8 +/- 1 and 11 +/- 3/8 +/- 1 mm Hg). The two drugs combined had a strongly positive interaction of 10 +/- 3/7 +/- 2 mm Hg (p less than 0.001). Enalapril can be used with the other therapeutic methods tested. If a converting enzyme inhibitor does not reduce BP adequately, it appears appropriate to add a thiazide diuretic or a slow-channel calcium-blocking drug. The mechanism of the positive interaction with diuretics probably reflects an effect on the renin-angiotensin system, but the explanation for the synergism with slow-channel calcium-blocking drugs is unclear.
虽然单一疗法有时能控制血压（BP），但通常必须加用第二种药物才能实现充分控制。本研究以析因方式考察了依那普利与一些常用抗高血压疗法之间的相互作用。每项研究中有10至16名患者，且这些患者对所使用的两种药物均有部分反应。依那普利和限钠分别使血压降低12±3/11±2和4±2/3±1 mmHg。两种疗法的效果是相加的，且无相互作用。依那普利和氢氯噻嗪分别使血压降低11±3/8±3和8±2/6±2 mmHg。两种药物联合使用的效果显示出4±2/3±1 mmHg的正性相互作用（p<0.05）。依那普利和硝苯地平均能降低血压（分别为10±2/8±1和11±3/8±1 mmHg）。两种药物联合使用产生了10±3/7±2 mmHg的强正性相互作用（p<0.001）。依那普利可与所测试的其他治疗方法联合使用。如果一种转换酶抑制剂不能充分降低血压，加用噻嗪类利尿剂或慢通道钙阻滞剂似乎是合适的。与利尿剂正性相互作用的机制可能反映了对肾素-血管紧张素系统的作用，但与慢通道钙阻滞剂协同作用的解释尚不清楚。
