Massie B M
Department of Medicine, University of California, San Francisco.
Am J Med. 1988 Apr 15;84(4A):36-46. doi: 10.1016/0002-9343(88)90468-8.
Although the underlying pathophysiology in most patients with congestive heart failure is impaired myocardial contractility, hemodynamic and clinical benefit can be achieved by treatment with agents that alter the loading conditions of the left ventricle. This was initially accomplished with direct-acting vasodilators such as sodium nitroprusside, nitrates, and hydralazine. Subsequently, the angiotensin converting enzyme (ACE) inhibitors have been demonstrated to produce similar short-term hemodynamic improvement and have generally proved superior in their long-term hemodynamic and clinical efficacy. Although the ACE inhibitors were initially employed as adjunctive treatment in patients with refractory heart failure, recent studies indicate that they are also effective in patients with mild and moderate symptoms and that they are at least as effective as digitalis in this patient group. Furthermore, a growing body of data indicates that the ACE inhibitors improve the survival rate in patients with severe and, possibly, milder heart failure. As a result, the ACE inhibitors have emerged as useful agents in patients with mild symptoms and are being investigated for their potential to improve the survival rate and prevent clinical deterioration in patients with asymptomatic or minimally symptomatic left ventricular dysfunction.
尽管大多数充血性心力衰竭患者的潜在病理生理学机制是心肌收缩力受损，但通过使用改变左心室负荷状况的药物进行治疗，可实现血流动力学和临床效益。这最初是通过直接作用的血管扩张剂如硝普钠、硝酸盐和肼苯哒嗪来实现的。随后，血管紧张素转换酶（ACE）抑制剂已被证明能产生类似的短期血流动力学改善，并且总体上在长期血流动力学和临床疗效方面更具优势。尽管ACE抑制剂最初被用作难治性心力衰竭患者的辅助治疗，但最近的研究表明，它们在症状较轻和中度的患者中也有效，并且在该患者群体中至少与洋地黄一样有效。此外，越来越多的数据表明，ACE抑制剂可提高重度以及可能轻度心力衰竭患者的生存率。因此，ACE抑制剂已成为症状较轻患者的有用药物，并且正在研究它们改善无症状或症状轻微的左心室功能不全患者生存率和预防临床病情恶化的潜力。
