Pitt B
University of Michigan Medical Center, Department of Internal Medicine, Ann Arbor 48109-0366.
Curr Opin Cardiol. 1994 May;9(3):289-94. doi: 10.1097/00001573-199405000-00005.
During 1993 the indications for the use of angiotensin-converting enzyme (ACE) inhibitors were expanded to include patients with left ventricular dysfunction and acute myocardial infarction. The role and use of ACE inhibitors in patients with chronic systolic ventricular dysfunction, established in earlier trials, has been further clarified. Increasing attention is being focused on ACE inhibitors, specifically the mechanisms by which they improve mortality, their side effects, and the possibility of further increasing their use by avoiding renal dysfunction and first-dose hypotension. Although most of the interest has centered on ACE inhibitors, the importance of diuretics and their use in combination with ACE inhibitors is being clarified. Most important has been the demonstration over the past year of the effectiveness of digoxin in preventing cardiac deterioration in patients with systolic left ventricular dysfunction and sinus rhythm. The increased understanding of the renin-angiotensin-aldosterone system, its modification by ACE inhibitors, and the interaction of ACE inhibition with other drugs provides the basis for a further improvement in morbidity and mortality in patients with heart failure.
1993年期间，血管紧张素转换酶（ACE）抑制剂的使用指征扩大到包括左心室功能不全和急性心肌梗死患者。早期试验确立的ACE抑制剂在慢性收缩性心室功能不全患者中的作用和应用得到了进一步阐明。人们越来越关注ACE抑制剂，特别是它们降低死亡率的机制、副作用，以及通过避免肾功能不全和首剂低血压来进一步增加其使用的可能性。尽管大部分关注都集中在ACE抑制剂上，但利尿剂的重要性及其与ACE抑制剂联合使用的情况也正在得到阐明。过去一年最重要的是证明了地高辛在预防收缩性左心室功能不全和窦性心律患者心脏恶化方面的有效性。对肾素 - 血管紧张素 - 醛固酮系统的进一步了解、ACE抑制剂对其的调节作用，以及ACE抑制与其他药物的相互作用，为进一步改善心力衰竭患者的发病率和死亡率提供了基础。
