Schneeweiss A, Green T, Krakuer J, Goldhamer E, Szucs T, Marmor A
Geriatric Cardiology Research Foundation, Tel-Aviv, Israel.
J Hum Hypertens. 1989 Aug;3(4):251-4.
Diastolic function may be impaired in hypertensives even before alterations occur in systolic function. We studied the effect of a single dose of cilazapril, 5 mg orally, on systolic and diastolic cardiac function in 20 hypertensive patients using a double-blind crossover placebo controlled design. All patients had mild to moderate concentric left ventricular hypertrophy, preserved systolic function and long standing hypertension (for a period of 11.9 +/- 9.0 years). Radionuclide scintigraphy was performed with cilazapril and placebo, given one week apart. A two-week washout period of all cardioactive drugs preceded the study. Within one hour of oral administration of cilazapril blood pressure was significantly lowered. The absolute time to peak filling rate of the left ventricle, as well as the time to peak filling rate expressed as a percentage of diastole, were reduced from 176 +/- 34 to 158 +/- 33 msec (P less than 0.01) and from 46 +/- 10% to 37 +/- 8% (P less than 0.02) (reduction by 9% and 18.4%, respectively). Heart rate, left and right ventricular ejection fraction and peak filling rate was not significantly altered. Placebo had no significant effect. The effect of cilazapril is most probably related to afterload reduction. In conclusion; cilazapril seems to improve diastolic cardiac function in hypertensive patients. Long-term therapy may result in improvement of other, less sensitive indices of diastolic dysfunction.
高血压患者即使在收缩功能出现改变之前，舒张功能也可能已受损。我们采用双盲交叉安慰剂对照设计，研究了口服单剂量5毫克西拉普利对20例高血压患者心脏收缩和舒张功能的影响。所有患者均有轻度至中度向心性左心室肥厚、收缩功能保留且患有长期高血压（病程为11.9±9.0年）。分别在服用西拉普利和安慰剂一周后进行放射性核素闪烁扫描。在研究前，所有心血管活性药物均有两周的洗脱期。口服西拉普利后一小时内血压显著降低。左心室峰值充盈率的绝对时间以及以舒张期百分比表示的峰值充盈率时间，分别从176±34毫秒降至158±33毫秒（P<0.01），从46±10%降至37±8%（P<0.02）（分别降低9%和18.4%）。心率、左心室和右心室射血分数以及峰值充盈率均无显著改变。安慰剂无显著作用。西拉普利的作用很可能与降低后负荷有关。总之，西拉普利似乎可改善高血压患者的心脏舒张功能。长期治疗可能会使舒张功能障碍的其他不太敏感指标得到改善。
