Packer M, Kessler P D, Gottlieb S S
Postgrad Med J. 1986;62 Suppl 1:179-82.
Although converting-enzyme inhibition is of established value in the management of patients with severe chronic congestive heart failure, troublesome adverse reactions occur frequently during the course of treatment and may cause physicians to interrupt effective therapy. The three most common adverse reactions that are seen in patients with heart failure following treatment with captopril and enalapril (symptomatic hypotension, functional renal insufficiency, hyperkalaemia) are predictable consequences of interfering with the homeostatic functions of the renin-angiotensin system, which evolved millions of years ago to preserve life in sodium-depleted states. It is not surprising, therefore, that these untoward effects can be prevented or reversed by increasing the dietary intake of salt or reducing the dose of concomitantly administered diuretics; their occurrence rarely requires discontinuation of drug therapy. Recognition of this link between sodium balance and the adverse effects of converting-enzyme inhibition is important, because most patients with severe heart failure who experience such untoward reactions can nevertheless be expected to improve clinically during long-term therapy, if effective treatment is not interrupted.
虽然转换酶抑制在重度慢性充血性心力衰竭患者的治疗中具有既定价值，但在治疗过程中经常会出现麻烦的不良反应，可能导致医生中断有效治疗。在用卡托普利和依那普利治疗心力衰竭的患者中出现的三种最常见不良反应（症状性低血压、功能性肾功能不全、高钾血症）是干扰肾素 - 血管紧张素系统稳态功能的可预测后果，该系统在数百万年前进化以在钠缺乏状态下维持生命。因此，通过增加盐的饮食摄入量或减少同时使用的利尿剂剂量可以预防或逆转这些不良影响也就不足为奇了；它们的发生很少需要停止药物治疗。认识到钠平衡与转换酶抑制不良反应之间的这种联系很重要，因为大多数经历此类不良反应的重度心力衰竭患者，如果不中断有效治疗，在长期治疗期间临床上仍有望改善。
