Niarchos A P, Roberts A J, Laragh J H
Am J Med. 1979 Nov;67(5):785-91. doi: 10.1016/0002-9343(79)90735-6.
The effects of the converting enzyme inhibitor (SQ 20881) on the pulmonary circulation were investigated in 13 patients in whom systemic hypertension developed following coronary artery bypass surgery. Pulmonary vascular resistance was decreased by the inhibitor, from 128 +/¿ 19 to 92 +/- 20 dynes sec cm-5 (or by 30 +/- 7 per cent; P less than 0.005), and this resulted in a decrease in mean pulmonary artery pressure from 17 +/- 1 to 13 +/- 1 mm Hg (or by 23 +/- 3 per cent, P less than 0.005). Consequently, right ventricular work was decreased by the inhibitor by 30 per cent (P less than 0.01), despite an increase in cardiac output (increase in stroke volume) by 16 +/- 6 per cent (P less than 01). This increase occurred despite a 13 +/- 3 per cent decrease in right ventricular filling pressure. The changes in pulmonary vascular resistance correlated with the pretreatment plasma renin activity (r = 0.74, P less than 0.01), as did the decrease in mean pulmonary artery pressure (R = 0.82, P less than 0.001), but neither change was related to the decrease in left ventricular fillling pressure nor to changes in cardiac output or mean arterial pressure. These results indicate that blockade of the formation of angiotensin II by the converting enzyme inhibitor results in reductions in pulmonary vascular resistance and pulmonary artery pressure which are unrelated to alterations in left ventricular function. Thus, angiotensin inhibition may have therapeutic value in various clinical states characterized by pulmonary hypertension--especially if renin levels are high.
在13例冠状动脉搭桥手术后出现系统性高血压的患者中，研究了转化酶抑制剂（SQ 20881）对肺循环的影响。该抑制剂使肺血管阻力从128±19降至92±20达因·秒·厘米⁻⁵（或降低30±7%；P<0.005），这导致平均肺动脉压从17±1降至13±1毫米汞柱（或降低23±3%，P<0.005）。因此，尽管心输出量增加（每搏量增加）16±6%（P<0.01），但该抑制剂仍使右心室做功降低30%（P<0.01）。尽管右心室充盈压降低了13±3%，心输出量仍出现了增加。肺血管阻力的变化与治疗前血浆肾素活性相关（r = 0.74，P<0.01），平均肺动脉压的降低也与之相关（R = 0.82，P<0.001），但这两种变化均与左心室充盈压的降低、心输出量或平均动脉压的变化无关。这些结果表明，转化酶抑制剂阻断血管紧张素II的形成会导致肺血管阻力和肺动脉压降低，且与左心室功能的改变无关。因此，血管紧张素抑制在各种以肺动脉高压为特征的临床状态中可能具有治疗价值——尤其是在肾素水平较高时。
