Kotamäki M, Manninen V, Laustiola K E
Wihuri Research Institute, Helsinki, Finland.
Eur J Clin Pharmacol. 1993;44(1):13-7. doi: 10.1007/BF00315273.
A randomised crossover study has been done to compare the antihypertensive efficacy of enalapril and atenolol in 45 smoking, hypertensive men. Treatment was started with enalapril 20 mg/d or atenolol 50 mg/d and, if necessary, the doses were doubled after 4 weeks to achieve a sitting diastolic blood pressure < or = 95 mm Hg, after which hydrochlorothiazide was added, if necessary. Both drugs lowered blood pressure significantly. However, enalapril was more efficient in lowering both systolic and diastolic blood pressure; the mean difference was significant after both 4 and 8 weeks in the sitting systolic (11.6 mm Hg and 7.9 mm Hg) and diastolic (3.3 mm Hg and 3.0 mm Hg) pressures and in the erect systolic pressures (8.2 mm Hg and 7.2 mm Hg), and after 8 weeks in the supine systolic pressure, too (8.9 mm Hg). The effect on enalapril was especially marked in moderate (< 20 cigarettes/day) smokers. The need for diuretics was also significantly less in the enalapril group. It appears that angiotensin-converting enzyme inhibitors may be superior to beta-adrenoceptor blockers in the treatment of hypertensive smoking patients.
一项随机交叉研究比较了依那普利和阿替洛尔对45名吸烟的高血压男性的降压效果。治疗开始时给予依那普利20mg/d或阿替洛尔50mg/d，必要时4周后剂量加倍，以达到坐位舒张压≤95mmHg，必要时在此基础上加用氢氯噻嗪。两种药物均能显著降低血压。然而，依那普利在降低收缩压和舒张压方面更有效；在坐位收缩压（4周时为11.6mmHg，8周时为7.9mmHg）、舒张压（4周时为3.3mmHg，8周时为3.0mmHg）和直立位收缩压（4周时为8.2mmHg，8周时为7.2mmHg）以及8周时的仰卧位收缩压（8.9mmHg）方面，平均差异均有统计学意义。依那普利对中度吸烟者（<20支/天）的效果尤为明显。依那普利组对利尿剂的需求也显著减少。在高血压吸烟患者的治疗中，血管紧张素转换酶抑制剂似乎优于β-肾上腺素能受体阻滞剂。
