Bursztyn M, Gavras I, Gourley L, DeSilva J, Whalen J, Gavras H
Department of Medicine, Boston University School of Medicine, Massachusetts.
Clin Ther. 1994 May-Jun;16(3):429-36.
The purpose of this study was to determine whether patients whose blood pressure failed to normalize while receiving monotherapy with atenolol would experience further blood pressure lowering by adding the angiotensin-converting enzyme (ACE) inhibitor benazepril hydrochloride to their treatment regimen. Seventy-four of the original 127 patients treated with atenolol met the criteria for entry into the 4-week, double-blind phase of the study, in which either benazepril 10 mg twice daily (increased after 1 week, if necessary, to 20 mg twice daily) or placebo was added to atenolol. At end point, 46% of the benazepril group had achieved an excellent or good response (ie, diastolic blood pressure [DBP] < 90 mm Hg or a decrease of > or = 10 mm Hg below the baseline) compared with 14% of the placebo group (P < 0.01). The mean fall in DBP at end point was -5.6 mm Hg in the benazepril group and -3.7 mm Hg in the placebo group. Because six patients in the benazepril group experienced an increase of blood pressure that offset the fall observed in the responders, the difference in DBP response between the benazepril group and the placebo group was not statistically significant. We conclude that adding benazepril to the regimen of patients whose blood pressure is inadequately controlled while receiving atenolol monotherapy can produce an additional decrease in blood pressure in almost half the patients.
本研究的目的是确定在接受阿替洛尔单一疗法时血压未能恢复正常的患者，在其治疗方案中添加盐酸苯那普利（一种血管紧张素转换酶[ACE]抑制剂）是否会进一步降低血压。最初接受阿替洛尔治疗的127例患者中，有74例符合进入该研究4周双盲阶段的标准，在此阶段，在阿替洛尔基础上加用每日两次、每次10 mg的苯那普利（必要时1周后增至每日两次、每次20 mg）或安慰剂。在研究终点，苯那普利组46%的患者获得了良好或优秀的反应（即舒张压[DBP]<90 mmHg或比基线水平降低≥10 mmHg），而安慰剂组为14%（P<0.01）。在研究终点，苯那普利组DBP的平均下降幅度为-5.6 mmHg，安慰剂组为-3.7 mmHg。由于苯那普利组有6例患者血压升高，抵消了反应者观察到的血压下降，因此苯那普利组和安慰剂组在DBP反应方面的差异无统计学意义。我们得出结论，对于接受阿替洛尔单一疗法但血压控制不佳的患者，在其治疗方案中添加苯那普利可使近半数患者的血压进一步下降。
