Van Mieghem W, Van Hedent T, Byttebier G
Department of Cardiology, A. Dumontkliniek, Genk, Belgium.
Acta Cardiol. 1993;48(1):43-53.
The acute haemodynamic effects of several equivalent dosages of lisinopril and captopril were compared in patients with severe class III or IV congestive heart failure. The evaluation was started with a low dose of 2.5 mg lisinopril o.d. or 6.25 mg captopril t.i.d. and subsequent daily increases to 5 and 10 mg lisinopril o.d. or 12.5 and 25 mg captopril t.i.d. Captopril had an earlier onset of action compared to lisinopril and caused larger diurnal fluctuations of the haemodynamic parameters. Lisinopril provoked a more pronounced decrease in pulmonary capillary wedge pressure (PCWP) than captopril and only lisinopril increased the cardiac index significantly. Side-effects of hypotension or increase in serum creatinine leading to withdrawal according to protocol were noted in 3 patients on each drug. Increases in dosage caused very little increase in haemodynamic effect, suggesting that complete suppression of the angiotensin-converting enzyme may not be necessary for an optimal clinical response.
在重度Ⅲ级或Ⅳ级充血性心力衰竭患者中，比较了几种等效剂量的赖诺普利和卡托普利的急性血流动力学效应。评估从低剂量开始，赖诺普利每日一次，每次2.5毫克，或卡托普利每日三次，每次6.25毫克，随后每日将赖诺普利剂量增至5毫克和10毫克，或卡托普利每日三次，每次增至12.5毫克和25毫克。与赖诺普利相比，卡托普利起效更早，且导致血流动力学参数的日间波动更大。赖诺普利引起的肺毛细血管楔压（PCWP）下降比卡托普利更显著，只有赖诺普利能显著提高心脏指数。每种药物各有3例患者出现低血压或血清肌酐升高的副作用，导致按方案停药。增加剂量对血流动力学效应的增加非常小，这表明对于最佳临床反应，可能无需完全抑制血管紧张素转换酶。
