Kjekshus J K, Søyland E, Dickstein K, Abrahamsen A M, Gundersen T
Br J Clin Pharmacol. 1984;18 Suppl 2(Suppl 2):169S-174S. doi: 10.1111/j.1365-2125.1984.tb02595.x.
Enalapril, a novel long acting angiotensin converting enzyme (ACE) inhibitor, was given orally to 12 patients with chronic heart failure (NYHA functional class III and IV) and cardiomegaly. The optimal dose averaged 17 mg given once-daily. Heart rate, systemic arterial blood pressure, pulmonary arterial pressure, right and left ventricular filling pressures and cardiac index were monitored during dose efficacy titration. Eleven patients were recatheterised 3 months later. After stabilisation of cardiac filling pressures, all patients had left ventricular filling pressures in excess of 20 mmHg. Enalapril increased cardiac index acutely by 34% but at 12 weeks follow-up, cardiac index was not different from control levels. Left ventricular filling pressure was reduced acutely by 36% and by 41% at 3 months. Heart rate, systemic arterial and right atrial pressures and plasma concentrations of aldosterone were reduced during the observation period. ACE activity was inhibited at the time of peak haemodynamic effect from 25.3 +/- 9.8 to 4.9 +/- 3.4 U/ml (P less than 0.01). Renin was markedly elevated. These changes were accompanied by marked and sustained clinical improvement and subjective well-being.
依那普利是一种新型长效血管紧张素转换酶（ACE）抑制剂，对12例慢性心力衰竭（纽约心脏协会心功能Ⅲ级和Ⅳ级）并伴有心脏扩大的患者进行了口服给药。最佳剂量平均为每日一次17毫克。在剂量疗效滴定期间监测心率、体循环动脉血压、肺动脉压、左右心室充盈压和心脏指数。3个月后对11例患者再次进行心导管检查。在心脏充盈压稳定后，所有患者的左心室充盈压均超过20 mmHg。依那普利可使心脏指数急性增加34%，但在12周随访时，心脏指数与对照水平无差异。左心室充盈压在急性时降低36%，在3个月时降低41%。在观察期内心率、体循环动脉压和右心房压以及醛固酮血浆浓度均降低。在血流动力学效应峰值时，ACE活性从25.3±9.8 U/ml抑制至4.9±3.4 U/ml（P<0.01）。肾素明显升高。这些变化伴随着显著且持续的临床改善和主观幸福感。
