van den Broek S A, de Graeff P A, van Veldhuisen D J, van Gilst W H, Hillege H, Wesseling H, Lie K I
Department of Cardiology/Thoraxcenter, University Hospital of Groningen, The Netherlands.
J Card Fail. 1997 Sep;3(3):165-71. doi: 10.1016/s1071-9164(97)90012-9.
This study was done to determine whether the difference in duration of action of the long-acting angiotensin-converting enzyme (ACE) inhibitor spirapril compared with the short-acting ACE inhibitor captopril affects clinical efficacy in patients with congestive heart failure.
The effects on exercise capacity, neurohumoral status, and quality of life were studied in 20 patients with mild to moderate congestive heart failure in a double-blind, randomized, comparative study in parallel groups with a duration of 12 weeks. All assessments during the study were performed in the morning, before intake of the study medication, to avoid the expected peak effect of the ACE inhibitors used. Mean peak oxygen consumption (peak Vo2) was 17.4 mL/min/kg (range, 14.2-19.9 mL/min/kg) and mean left ventricular ejection fraction was 28% (range, 13-40%). Exercise duration in the captopril group showed a significant increase after 12 weeks (P < .05) of treatment compared with the spirapril group. Peak oxygen consumption tended only to increase in the captopril-treated patients compared with the spirapril-treated patients. Serum ACE activity was significantly different between the two treatment groups during treatment (P < .0001) and showed only a significant decrease in the spirapril group. There was no difference in improvement of quality of life between the two treatment groups.
This study showed that the effects of the ACE inhibitors spirapril and captopril on exercise capacity are not related to the degree of inhibition of serum ACE activity.
本研究旨在确定长效血管紧张素转换酶（ACE）抑制剂螺普利与短效ACE抑制剂卡托普利作用持续时间的差异是否会影响充血性心力衰竭患者的临床疗效。
在一项为期12周的双盲、随机、平行组对照研究中，对20例轻至中度充血性心力衰竭患者的运动能力、神经体液状态和生活质量的影响进行了研究。研究期间的所有评估均在早晨、服用研究药物之前进行，以避免所用ACE抑制剂预期的峰值效应。平均峰值耗氧量（峰值Vo2）为17.4 mL/min/kg（范围为14.2 - 19.9 mL/min/kg），平均左心室射血分数为28%（范围为13 - 40%）。与螺普利组相比，卡托普利组治疗12周后运动持续时间显著增加（P < 0.05）。与螺普利治疗的患者相比，卡托普利治疗的患者峰值耗氧量仅呈增加趋势。治疗期间两组治疗组的血清ACE活性有显著差异（P < 0.0001），且仅螺普利组出现显著下降。两组治疗组在生活质量改善方面无差异。
本研究表明，ACE抑制剂螺普利和卡托普利对运动能力的影响与血清ACE活性的抑制程度无关。
