Abrams W B, Davies R O, Ferguson R K
Fed Proc. 1984 Apr;43(5):1314-21.
Angiotensin-converting enzyme (ACE) inhibitors favorably modify control mechanisms that are disturbed in hypertension and congestive heart failure, principally, but perhaps not exclusively, through reduction in angiotensin II levels. Pharmacodynamic actions are vasodilation, increased sodium excretion, and lowering of blood pressure. Investigations with captopril and enalapril in the treatment of hypertension indicate efficacies comparable to each other and to current step 1 and 2 agents. Enalapril is more potent than captopril and has a longer duration of action. The hemodynamic mechanism of action is reduction in peripheral vascular resistance. Addition of a diuretic potentiates blood pressure lowering and proportion of patients responding. When used in congestive heart failure, ACE inhibitors exert a balanced vasodilator effect on arterial and venous beds and do not induce tachycardia or fluid retention. Cardiac output is increased whereas systemic vascular resistance, central pressures, and systemic blood pressure are reduced acutely and chronically. Although captopril is associated with certain side effects, possibly resulting from the sulfhydryl group in its structure, this profile has not been encountered thus far in clinical investigations with enalapril. The effects of ACE inhibitors on the natural histories of hypertension (independent of blood pressure lowering) and congestive heart failure are yet to be determined.
血管紧张素转换酶（ACE）抑制剂可改善高血压和充血性心力衰竭中紊乱的调控机制，主要但可能并非仅仅通过降低血管紧张素II水平来实现。其药效学作用包括血管舒张、增加钠排泄和降低血压。卡托普利和依那普利治疗高血压的研究表明，二者疗效相当，且与目前的1级和2级治疗药物相当。依那普利比卡托普利更有效，作用持续时间更长。其血流动力学作用机制是降低外周血管阻力。加用利尿剂可增强降压效果及提高患者的反应比例。当用于充血性心力衰竭时，ACE抑制剂对动脉和静脉床发挥平衡的血管舒张作用，不会诱发心动过速或液体潴留。心输出量增加，而全身血管阻力、中心压力和全身血压在急性和慢性期均降低。虽然卡托普利会产生某些副作用，可能源于其结构中的巯基，但依那普利的临床研究中尚未出现这种情况。ACE抑制剂对高血压（独立于降压作用）和充血性心力衰竭自然病程的影响尚未确定。
