Ghose J C, Chakraborty S, Mondal M, Bhandari B
Department of Cardiology, NRS Medical College Hospital, Calcutta.
J Assoc Physicians India. 1993 May;41(5):269-71.
We compared the effects of Hydralazine and Isosorbide dinitrate (ISDN) with those of an angiotensin-converting-enzyme inhibitor, captopril on mortality in patients with chronic congestive heart failure (NYHA class III and IV). Patients receiving conventional treatment with digoxin and diuretics were randomly assigned to receive either placebo (n = 51), hydralazine-ISDN. (n = 50) or captopril (n = 52) in a double blind trial. At the end of 6 months there were 14 deaths in the placebo group (27.4%) as compared with 11 deaths in the hydralazine-ISDN group (22%)--a mortality reduction of 20% (P > 0.05) and 10 deaths in the captopril group (19.2%)--a mortality reduction of 30% (p > 0.05). At the end of one year, mortality was 50%, 42% and 30% in the placebo, hydralazine-ISDN and captopril groups respectively with a mortality reduction of 16% in the hydralazine-ISDN group (p > 0.05) and 40% in the captopril group (p < 0.05) compared to the placebo group. The mortality reduction was mainly due to reduction in deaths attributed to progressive heart failure. The data suggests that the addition of captopril to conventional treatment significantly reduces mortality in patients with severe congestive heart failure. Hydralazine-isorobide dinitrate also reduced mortality but statistically this was not significant.
我们比较了肼屈嗪和硝酸异山梨酯（ISDN）与血管紧张素转换酶抑制剂卡托普利对慢性充血性心力衰竭（纽约心脏协会III级和IV级）患者死亡率的影响。接受地高辛和利尿剂常规治疗的患者在一项双盲试验中被随机分配接受安慰剂（n = 51）、肼屈嗪 - ISDN（n = 50）或卡托普利（n = 52）治疗。6个月结束时，安慰剂组有14例死亡（27.4%），肼屈嗪 - ISDN组有11例死亡（22%）——死亡率降低了20%（P>0.05），卡托普利组有10例死亡（19.2%）——死亡率降低了30%（P>0.05）。1年结束时，安慰剂组、肼屈嗪 - ISDN组和卡托普利组的死亡率分别为50%、42%和30%，与安慰剂组相比，肼屈嗪 - ISDN组死亡率降低了16%（P>0.05），卡托普利组死亡率降低了40%（P<0.05）。死亡率降低主要归因于进行性心力衰竭导致的死亡减少。数据表明，在常规治疗中加用卡托普利可显著降低重度充血性心力衰竭患者的死亡率。肼屈嗪 - 硝酸异山梨酯也降低了死亡率，但在统计学上不显著。
