Linn W D
Department of Medicine, Audie Murphy Veterans Administration Hospital, San Antonio, Texas 78284, USA.
Pharmacotherapy. 1996 Mar-Apr;16(2 Pt 2):50S-58S.
Angiotensin-converting enzyme (ACE) inhibitors have been used for more than a decade in the treatment of chronic congestive heart failure. In recent years these agents have been used in patients who survived a myocardial infarction. However, primary care providers are often confused as to which patients would benefit the most, and as a result, these life-prolonging drugs are underutilized. The results of randomized controlled trials evaluating ACE inhibitors' effect on morbidity and mortality in patients with chronic congestive heart failure or acute myocardial infarction were evaluated. Angiotensin-converting enzyme inhibitors clearly improve survival in patients with symptomatic congestive heart failure. This survival benefit is approximately 6 months. In patients with asymptomatic systolic dysfunction, these agents also decrease the number of hospital admissions due to heart failure. Angiotensin-converting enzyme inhibitors also improve survival in all patients who experienced an acute myocardial infarction. With the plethora of evidence regarding the positive effects that this class of drugs has on the quality of life and survival of patients with systolic dysfunction, it is still unclear why clinicians are reluctant to use them more often. Primary care providers need to be educated on how to risk stratify patients to make this therapy more cost effective, and when these agents should be started.
血管紧张素转换酶（ACE）抑制剂已用于治疗慢性充血性心力衰竭十多年。近年来，这些药物也用于心肌梗死后存活的患者。然而，初级保健提供者常常不清楚哪些患者受益最大，结果，这些延长生命的药物未得到充分利用。对评估ACE抑制剂对慢性充血性心力衰竭或急性心肌梗死患者发病率和死亡率影响的随机对照试验结果进行了评估。血管紧张素转换酶抑制剂明显改善有症状充血性心力衰竭患者的生存率。这种生存获益约为6个月。在无症状收缩功能障碍患者中，这些药物还减少了因心力衰竭导致的住院次数。血管紧张素转换酶抑制剂也能改善所有急性心肌梗死患者的生存率。尽管有大量证据表明这类药物对收缩功能障碍患者的生活质量和生存率有积极影响，但临床医生为何仍不愿更频繁地使用它们仍不清楚。需要对初级保健提供者进行教育，让他们了解如何对患者进行风险分层以使这种治疗更具成本效益，以及何时开始使用这些药物。
