Ando K, Fujita T, Ito Y, Noda H, Yamashita K
Am Heart J. 1986 Feb;111(2):347-52. doi: 10.1016/0002-8703(86)90152-3.
To evaluate the role of regional hemodynamics in mediating the long-term depressor effect of the converting enzyme inhibitor, captopril, at a low dose (37.5 mg/day), for 2 weeks, its systemic, renal, and forearm circulatory actions were determined in 12 patients with mild to moderate essential hypertension. After administration of captopril, there was a significant decline in mean blood pressure (average -12.1 +/- 1.9%) accompanied by a decrease in systemic vascular resistance (-9.1 +/- 3.3%), but cardiac output did not change. Although forearm vascular resistance was not altered, renal vascular resistance decreased considerably (-17.1 +/- 5.0%). Moreover, there was a highly significant (r = 0.891) correlation between the changes in mean blood pressure and renal vascular resistance. Plasma renin activity increased after therapy as plasma aldosterone decreased, while plasma norepinephrine slightly increased. The change in renal vascular resistance significantly (r = -0.617) correlated with the pretreatment level of plasma renin activity. These findings suggest that suppression of the renin-angiotensin system in essential hypertension induces selective vasodilation in the renal vasculature, which may play an important role in the long-term antihypertensive effect of the converting enzyme inhibitor. This renal vasodilator action appears to be the feature that distinguishes the converting enzyme inhibitor from conventional vasodilator drugs.
为评估低剂量（37.5毫克/天）的转换酶抑制剂卡托普利持续2周的长期降压作用中局部血流动力学的作用，对12例轻至中度原发性高血压患者测定了其全身、肾脏及前臂循环作用。给予卡托普利后，平均血压显著下降（平均-12.1±1.9%），同时全身血管阻力降低（-9.1±3.3%），但心输出量未改变。虽然前臂血管阻力未改变，但肾血管阻力显著降低（-17.1±5.0%）。此外，平均血压变化与肾血管阻力变化之间存在高度显著的相关性（r = 0.891）。治疗后血浆肾素活性升高，同时血浆醛固酮降低，而血浆去甲肾上腺素略有升高。肾血管阻力变化与治疗前血浆肾素活性水平显著相关（r = -0.617）。这些发现表明，原发性高血压中肾素-血管紧张素系统的抑制可诱导肾血管选择性舒张，这可能在转换酶抑制剂的长期降压作用中起重要作用。这种肾血管舒张作用似乎是转换酶抑制剂区别于传统血管扩张药物的特征。
