Goa K L, Haria M, Wilde M I
Adis International Limited, Auckland, New Zealand.
Drugs. 1997 Jun;53(6):1081-105. doi: 10.2165/00003495-199753060-00010.
Lisinopril, like other ACE inhibitors, lowers blood pressure and preserves renal function in hypertensive patients with non-insulin-dependent or insulin-dependent diabetes mellitus (NIDDM or IDDM) and early or overt nephropathy, without adversely affecting glycaemic control or lipid profiles. On available evidence, renoprotective effects appear to be greater with lisinopril than with comparator calcium channel blockers, diuretics and beta-blockers, despite similar antihypertensive efficacy. As shown by the EUCLID (EUrodiab Controlled trial of Lisinopril in Insulin-Dependent Diabetes) trial, lisinopril is also renoprotective in normotensive patients with IDDM and microalbuminuria. The effect in normotensive patients with normoalbuminuria was smaller than in those with microalbuminuria, and no conclusions can yet be made about its use in patients with normoalbuminuria. In complications other than nephropathy, lisinopril has shown some benefit. Progression to retinopathy was slowed during 2 years' lisinopril therapy in the EUCLID study. Although not yet fully published, these results provide the most convincing evidence to date for an effect of an ACE inhibitor in retinopathy. The drug may also improve neurological function, but this finding is preliminary. Lastly, post hoc analysis of the GISSI-3 trial indicates that lisinopril reduces 6-week mortality rates in diabetic patients when begun as early treatment after an acute myocardial infarction. The tolerability profile of lisinopril is typical of ACE inhibitors and appears to be similar in diabetic and nondiabetic individuals. Hypoglycaemia has occurred at a similar frequency with lisinopril and placebo, as shown in the EUCLID trial. In addition, the GISSI-3 study indicates that the incidence of persistent hypotension and renal dysfunction is increased with lisinopril in general, but the presence of diabetes does not appear to confer additional risk of these events in diabetic patients with acute myocardial infarction receiving lisinopril. In summary, lisinopril lowers blood pressure and produces a renoprotective effect in patients with IDDM and NIDDM without detriment to glycaemic control or lipid profiles. Like other ACE inhibitors, lisinopril should thus be viewed as a first-line agent for reducing blood pressure and preventing or attenuating nephropathy in hypertensive diabetic patients with IDDM or NIDDM and microalbuminuria or overt renal disease. The EUCLID study, using lisinopril, provides new data supporting an additional place in managing normotensive patients with microalbuminuria and IDDM. These findings, together with some evidence for an effect of lisinopril in delaying progression of retinopathy and in reducing mortality, suggest a broader role for the drug in managing diabetic vascular complications.
赖诺普利与其他血管紧张素转换酶（ACE）抑制剂一样，可降低血压，并在患有非胰岛素依赖型或胰岛素依赖型糖尿病（NIDDM或IDDM）以及早期或显性肾病的高血压患者中保护肾功能，且不会对血糖控制或血脂水平产生不利影响。根据现有证据，尽管降压效果相似，但赖诺普利的肾脏保护作用似乎比对照钙通道阻滞剂、利尿剂和β受体阻滞剂更大。如欧盟糖尿病（EUCLID，EUrodiab Controlled trial of Lisinopril in Insulin - Dependent Diabetes）试验所示，赖诺普利对患有IDDM和微量白蛋白尿的血压正常患者也有肾脏保护作用。对尿白蛋白正常的血压正常患者的作用小于对微量白蛋白尿患者的作用，目前对于其在尿白蛋白正常患者中的应用尚无定论。在肾病以外的并发症方面，赖诺普利已显示出一些益处。在EUCLID研究中，赖诺普利治疗2年期间，视网膜病变的进展减缓。尽管这些结果尚未完全发表，但它们为ACE抑制剂对视网膜病变的作用提供了迄今为止最有说服力的证据。该药物还可能改善神经功能，但这一发现尚属初步。最后，GISSI - 3试验的事后分析表明，急性心肌梗死后早期开始使用赖诺普利可降低糖尿病患者6周时的死亡率。赖诺普利的耐受性特征是ACE抑制剂的典型特征，在糖尿病患者和非糖尿病患者中似乎相似。如EUCLID试验所示，赖诺普利和安慰剂导致低血糖的发生率相似。此外，GISSI - 3研究表明，一般情况下赖诺普利会增加持续性低血压和肾功能不全的发生率，但在接受赖诺普利治疗的急性心肌梗死糖尿病患者中，糖尿病的存在似乎并未增加这些事件的额外风险。总之，赖诺普利可降低血压，并在IDDM和NIDDM患者中产生肾脏保护作用，而不会损害血糖控制或血脂水平。因此，与其他ACE抑制剂一样，赖诺普利应被视为高血压糖尿病患者（IDDM或NIDDM，伴有微量白蛋白尿或显性肾病）降低血压以及预防或减轻肾病的一线药物。使用赖诺普利的EUCLID研究提供了新的数据，支持其在治疗微量白蛋白尿和IDDM的血压正常患者中发挥额外作用。这些发现，连同赖诺普利在延缓视网膜病变进展和降低死亡率方面的一些证据，表明该药物在管理糖尿病血管并发症方面具有更广泛的作用。
