Herrick A L, Waller P C, Berkin K E, Pringle S D, Callender J S, Robertson M P, Findlay J G, Murray G D, Reid J L, Lorimer A R
Glasgow Blood Pressure Clinic, University of Glasgow, Scotland.
Am J Med. 1989 Apr;86(4):421-6. doi: 10.1016/0002-9343(89)90340-9.
Short-term therapy with angiotensin converting enzyme (ACE) inhibitors for hypertension is effective and well tolerated, and compared with beta blockers, may cause fewer adverse reactions. Furthermore, enalapril has been observed to have a greater effect on systolic blood pressure than beta blockers. We therefore decided to compare the ACE inhibitor enalapril and the beta blocker atenolol as monotherapy in a double-blind study of patients with mild to moderate hypertension.
After a four-week placebo run-in period, 162 patients were allocated randomly to receive atenolol (50 to 100 mg daily) or enalapril (20 to 40 mg daily) for 12 weeks. To assess the influence of these drugs on quality of life, a series of psychologic tests was performed, and a subset of patients also underwent treadmill exercise and pulmonary function tests.
In 147 patients who completed the study, enalapril reduced supine blood pressure by 19/12 mm Hg, compared with 9/7 mm Hg for atenolol (p less than 0.001/p less than 0.005). The modest blood pressure response to atenolol was not due to poor compliance. A target blood pressure of 140/90 mm Hg or less was achieved by 35 percent of enalapril-treated atenolol (p less than 0.01). The frequency and severity of adverse effects with the two drugs were similar, and few important differences emerged from the quality-of-life assessments.
At the doses used, enalapril induced a greater short-term blood pressure response than atenolol; long-term studies of its safety and efficacy are required.
血管紧张素转换酶（ACE）抑制剂用于高血压的短期治疗有效且耐受性良好，与β受体阻滞剂相比，不良反应可能更少。此外，已观察到依那普利对收缩压的影响大于β受体阻滞剂。因此，我们决定在一项针对轻至中度高血压患者的双盲研究中，比较ACE抑制剂依那普利和β受体阻滞剂阿替洛尔作为单一疗法的效果。
在为期四周的安慰剂导入期后，162例患者被随机分配接受阿替洛尔（每日50至100毫克）或依那普利（每日20至40毫克）治疗12周。为评估这些药物对生活质量的影响，进行了一系列心理测试，部分患者还接受了跑步机运动和肺功能测试。
在完成研究的147例患者中，依那普利使仰卧位血压降低19/12毫米汞柱，而阿替洛尔为9/7毫米汞柱（p<0.001/p<0.005）。阿替洛尔血压反应适度并非由于依从性差。依那普利治疗组有35%的患者达到了140/90毫米汞柱或更低的目标血压，而阿替洛尔组为19%（p<0.01）。两种药物不良反应的频率和严重程度相似，生活质量评估中未出现重要差异。
在所使用的剂量下，依那普利比阿替洛尔引起更大的短期血压反应；需要对其安全性和疗效进行长期研究。
