Pitt B
University of Michigan School of Medicine, USA.
Br J Clin Pract Suppl. 1996 Jul;84:11-6.
The ACE inhibitors have been found effective in reducing the morbidity and mortality of both post-infarction patients and those with chronic systolic left ventricular dysfunction. However, their use is limited--particularly in elderly patients because of poor tolerance partly due to bradykinin-induced side-effects such as renal dysfunction, first-dose hypotension, and cough. Thus, the introduction of the angiotensin II type I receptor antagonists--that block the effects of angiotensin II without increasing bradykinin concentration--may be particularly important in the treatment of elderly patients. The role of the angiotensin II type I receptor antagonists in patients with systolic left ventricular dysfunction is currently being explored in direct comparison with and in conjunction with the ACE inhibitors. Furthermore, important questions about the most effective dose of ACE inhibitor and ACE inhibitor use in conjunction with aspirin and the NSAIDs still have to be answered. Thus, although we have learnt much about the role of ACE inhibitors in heart failure treatment, we are still at an early stage in the application of this knowledge, particularly in elderly patients.
已发现血管紧张素转换酶（ACE）抑制剂可有效降低心肌梗死后患者以及慢性收缩性左心室功能不全患者的发病率和死亡率。然而，其应用受到限制——尤其是在老年患者中，原因是耐受性差，部分原因是缓激肽引起的副作用，如肾功能不全、首剂低血压和咳嗽。因此，引入血管紧张素II 1型受体拮抗剂——可在不增加缓激肽浓度的情况下阻断血管紧张素II的作用——在老年患者的治疗中可能尤为重要。血管紧张素II 1型受体拮抗剂在收缩性左心室功能不全患者中的作用目前正在与ACE抑制剂进行直接比较并联合使用时进行探索。此外，关于ACE抑制剂的最有效剂量以及ACE抑制剂与阿司匹林和非甾体抗炎药联合使用的重要问题仍有待解答。因此，尽管我们对ACE抑制剂在心力衰竭治疗中的作用已经了解很多，但在应用这些知识方面我们仍处于早期阶段，尤其是在老年患者中。
