Hirschl M M, Binder M, Bur A, Herkner H, Brunner M, Müllner M, Sterz F, Laggner A N
Department of Emergency Medicine, University of Vienna, Austria.
Arch Intern Med. 1995 Nov 13;155(20):2217-23.
The appropriate dose of intravenous enalaprilat to be used in the treatment of hypertensive crisis is controversial. There has been no comparative study of the efficacy and safety of different dosages of enalaprilat in hypertensive patients.
Sixty-five consecutive patients with hypertensive urgencies (systolic blood pressure > 210 mm Hg and/or diastolic blood pressure > 110 mm Hg) or emergencies (diastolic blood pressure > 100 mm Hg and evidence of end-organ damage, ie, angina pectoris, hypertensive encephalopathy, or congestive heart failure) admitted to an emergency department from January 1, 1994, to September 30, 1994, were identified. The patients were randomized to receive different doses of enalaprilat (0.625, 1.25, 2.5, and 5 mg). Response to treatment was defined as a stable reduction of systolic blood pressure to below 180 mm Hg and diastolic blood pressure to below 95 mm Hg within 45 minutes after the start of treatment and relief of symptoms in patients with hypertensive emergencies.
In 41 (63%) of 65 patients, the treatment goal was reached. Twenty-four patients (37%) failed to achieve the goal of treatment within 45 minutes after administration of enalaprilat. The response rates in the 0.625-mg, 1.25-mg, 2.5-mg, and 5-mg groups were 67%, 65%, 59%, and 62%, respectively. The proportion of patients initially randomized who responded to treatment was not different between any of the four groups of enalaprilat doses. There were no significant differences according to enalaprilat dose with respect to changes in systolic, diastolic, and mean arterial blood pressure. No severe side effects were observed.
Enalaprilat is a safe antihypertensive drug with moderate efficacy in the treatment of hypertensive crisis. As doses above 0.625 mg alter neither response rates nor the magnitude of blood pressure reduction, we recommend 0.625 mg as the initial dose in the treatment of hypertensive crisis.
用于治疗高血压急症的静脉注射依那普利拉的合适剂量存在争议。目前尚无关于不同剂量依那普利拉在高血压患者中的疗效和安全性的比较研究。
确定了1994年1月1日至1994年9月30日期间连续收治入急诊科的65例高血压急症（收缩压>210 mmHg和/或舒张压>110 mmHg）或高血压亚急症（舒张压>100 mmHg且有靶器官损害证据，即心绞痛、高血压脑病或充血性心力衰竭）患者。患者被随机分配接受不同剂量的依那普利拉（0.625、1.25、2.5和5 mg）。治疗反应定义为治疗开始后45分钟内收缩压稳定降至180 mmHg以下且舒张压降至95 mmHg以下，以及高血压亚急症患者症状缓解。
65例患者中有41例（63%）达到治疗目标。24例患者（37%）在给予依那普利拉后45分钟内未达到治疗目标。0.625 mg、1.25 mg、2.5 mg和5 mg组的反应率分别为67%、65%、59%和62%。四组依那普利拉剂量中，最初随机分组的患者中对治疗有反应的比例在任何一组之间均无差异。依那普利拉剂量在收缩压、舒张压和平均动脉压变化方面无显著差异。未观察到严重副作用。
依那普利拉是一种安全的抗高血压药物，在治疗高血压急症方面疗效中等。由于0.625 mg以上的剂量既不改变反应率也不改变血压降低幅度，我们建议将0.625 mg作为治疗高血压急症的初始剂量。
