Leonetti G, Trimarco B, Collatina S, Tosetti A
IRCCS Ospedale S. Luca, Centro Auxologico Italiano and Cattedra Terapia Medica, Universitá di Milano, Milan, Italy.
Am J Hypertens. 1997 Oct;10(10 Pt 2):230S-235S. doi: 10.1016/s0895-7061(97)00328-2.
Cardiovascular diseases are the most common causes of mortality, and hypertension is the most common cardiovascular disease in all ages. The Systolic Hypertension in the Elderly Program (SHEP) trial has shown that the pharmacologic reduction of isolated systolic hypertension can significantly reduce the incidence of cardiovascular complications. The aim of the Italian multicenter study reported here is to compare the efficacy, safety, and tolerability of fosinopril, a novel angiotensin converting enzyme (ACE) inhibitor with a dual route of excretion, with chlorthalidone, the diuretic administered in the SHEP study, in 312 elderly patients with isolated systolic hypertension. Our results show that fosinopril and chlorthalidone produce identical and statistically significant reductions in systolic blood pressure (-23.9 +/- 11.6 mm Hg and -23.7 +/- 10.9 mm Hg, respectively) and, to a lesser extent, in diastolic blood pressure (-7.1 +/- 3.1 mm Hg and -5.2 +/- 2.3 mm Hg, respectively). Only chlorthalidone caused a statistically significant change in uric acid, total cholesterol, blood urea, and serum potassium concentrations. Fosinopril was also somewhat better tolerated than chlorthalidone. In conclusion, the novel ACE inhibitor fosinopril is an effective and well-tolerated antihypertensive agent for use in elderly patients with isolated systolic hypertension and appears to be a suitable alternative for the treatment of isolated systolic hypertension.
心血管疾病是最常见的死亡原因，而高血压是各年龄段最常见的心血管疾病。老年收缩期高血压计划（SHEP）试验表明，单纯收缩期高血压的药物治疗可显著降低心血管并发症的发生率。本文报道的意大利多中心研究的目的是比较福辛普利（一种具有双重排泄途径的新型血管紧张素转换酶（ACE）抑制剂）与SHEP研究中使用的利尿剂氯噻酮，在312例老年单纯收缩期高血压患者中的疗效、安全性和耐受性。我们的结果表明，福辛普利和氯噻酮在降低收缩压方面产生了相同且具有统计学意义的效果（分别为-23.9±11.6 mmHg和-23.7±10.9 mmHg），在降低舒张压方面的效果稍弱（分别为-7.1±3.1 mmHg和-5.2±2.3 mmHg）。只有氯噻酮导致尿酸、总胆固醇、血尿素和血清钾浓度发生了具有统计学意义的变化。福辛普利的耐受性也比氯噻酮稍好。总之，新型ACE抑制剂福辛普利是治疗老年单纯收缩期高血压的一种有效且耐受性良好的抗高血压药物，似乎是治疗单纯收缩期高血压的合适替代药物。
