Levine T B, Olivari M T, Cohn J N
Am J Med. 1986 Oct 31;81(4C):36-9. doi: 10.1016/0002-9343(86)90943-5.
In this study, the use of enalapril and captopril is compared in the treatment of congestive heart failure. Although both drugs act on the renin-angiotensin system via converting enzyme inhibition, their different chemical structures may dispose them to different pharmacologic and physiologic activity. Both drugs exert a vasodilator effect, with reduction of left and right ventricular filling pressures and aortic impedance. In short-term hemodynamic studies, the onset of action and peak effect are earlier with captopril. Enalapril has a much more gradual onset and longer duration of action. Both drugs have a shallow dose-response curve and both produce comparable hormonal changes: an increase in plasma renin activity and a decrease in aldosterone levels. Captopril also increases prostaglandin production. Long-term efficacy trials have demonstrated symptomatic improvement in patients given captopril and those receiving enalapril who were also receiving digitalis and diuretics. Baseline hemodynamics may not predict long-term improvement. There are few adverse effects for the two drugs, but their incidences differ, suggesting a relationship to chemical structure. Recent studies in congestive heart failure suggest a reduction in mortality with various drug regimens.
在本研究中，对依那普利和卡托普利治疗充血性心力衰竭的效果进行了比较。尽管两种药物均通过抑制转换酶作用于肾素 - 血管紧张素系统，但它们不同的化学结构可能使其具有不同的药理和生理活性。两种药物均发挥血管舒张作用，可降低左、右心室充盈压及主动脉阻抗。在短期血流动力学研究中，卡托普利的起效时间和达到峰值效应的时间更早。依那普利的起效则更为缓慢，作用持续时间更长。两种药物的剂量 - 反应曲线均较平缓，且都会引起类似的激素变化：血浆肾素活性升高，醛固酮水平降低。卡托普利还会增加前列腺素的生成。长期疗效试验表明，接受卡托普利治疗的患者以及同时接受洋地黄和利尿剂治疗且服用依那普利的患者症状均有改善。基线血流动力学情况可能无法预测长期疗效。两种药物的不良反应均较少，但发生率有所不同，这表明不良反应与化学结构有关。近期针对充血性心力衰竭的研究表明，采用各种药物治疗方案均可降低死亡率。
