Barcina Sánchez C, Martín Cortés M, Fernández Fernández A
Zeneca Farma, S.A. Departamento Médico, Madrid.
An Med Interna. 1995 May;12(5):246-53.
The prognosis in patients with heart failure (HF) is poor. The angiotensin converting enzyme (ACE) inhibitors are among the most promising of current options, with benefits not only in terms of haemodynamic and clinical improvement but also in mortality. Data are reviewed comparing the once-daily ACE inhibitor lisinopril with captopril or enalapril in patients already receiving digoxin and/or diuretics for heart failure. Data are also reviewed which compare lisinopril with digoxin in patients already receiving diuretics alone for heart failure. Lisinopril is more effective than placebo and at least as effective as captopril or enalapril in these comparative studies on the basis of haemodynamics, exercise test results and clinical signs and symptoms of heart failure. Lisinopril may also be a suitable alternative, as well as being an adjunct, to digoxin in patients already receiving diuretics alone. Lisinopril is usually well tolerated in patients with heart failure. The mechanism of benefit of ACE inhibitors in heart failure is not clear, but apart from blockade of the renin-angiotensin-aldosterone system (RAAS), may also involve modulation of sympathetic stimulation, cardioreparation and regulation of potassium balance. The new ATLAS study (Assessment of Treatment with Lisinopril And Survival) is being conducted to address the question of whether ACE inhibitors in general practice should be given at the current low doses, or at the higher doses used in large survival studies.
心力衰竭（HF）患者的预后较差。血管紧张素转换酶（ACE）抑制剂是目前最有前景的治疗选择之一，不仅在血流动力学和临床改善方面有益，而且对死亡率也有影响。本文回顾了在已经接受地高辛和/或利尿剂治疗心力衰竭的患者中，将每日一次的ACE抑制剂赖诺普利与卡托普利或依那普利进行比较的数据。还回顾了在仅接受利尿剂治疗心力衰竭的患者中，将赖诺普利与地高辛进行比较的数据。在这些基于血流动力学、运动试验结果以及心力衰竭临床体征和症状的比较研究中，赖诺普利比安慰剂更有效，并且至少与卡托普利或依那普利一样有效。对于已经仅接受利尿剂治疗的患者，赖诺普利可能也是地高辛的合适替代药物以及辅助药物。心力衰竭患者通常对赖诺普利耐受性良好。ACE抑制剂在心力衰竭中的获益机制尚不清楚，但除了阻断肾素-血管紧张素-醛固酮系统（RAAS）外，可能还涉及调节交感神经刺激、心脏修复和钾平衡调节。正在进行新的ATLAS研究（赖诺普利治疗与生存评估），以解决在一般临床实践中，ACE抑制剂应给予目前的低剂量还是在大型生存研究中使用的高剂量这一问题。
