Brown N J, Vaughan D E
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn 37232-6602, USA.
Circulation. 1998 Apr 14;97(14):1411-20. doi: 10.1161/01.cir.97.14.1411.
ACE inhibitors have achieved widespread usage in the treatment of cardiovascular and renal disease. ACE inhibitors alter the balance between the vasoconstrictive, salt-retentive, and hypertrophic properties of angiotensin II (Ang II) and the vasodilatory and natriuretic properties of bradykinin and alter the metabolism of a number of other vasoactive substances. ACE inhibitors differ in the chemical structure of their active moieties, in potency, in bioavailability, in plasma half-life, in route of elimination, in their distribution and affinity for tissue-bound ACE, and in whether they are administered as prodrugs. Thus, the side effects of ACE inhibitors can be divided into those that are class specific and those that relate to specific agents. ACE inhibitors decrease systemic vascular resistance without increasing heart rate and promote natriuresis. They have proved effective in the treatment of hypertension, they decrease mortality in congestive heart failure and left ventricular dysfunction after myocardial infarction, and they delay the progression of diabetic nephropathy. Ongoing studies will elucidate the effect of ACE inhibitors on cardiovascular mortality in essential hypertension, the role of ACE inhibitors in patients without ventricular dysfunction after myocardial infarction, and the role of ACE inhibitors compared with newly available angiotensin AT1 receptor antagonists.
血管紧张素转换酶（ACE）抑制剂已广泛用于治疗心血管疾病和肾脏疾病。ACE抑制剂改变了血管紧张素II（Ang II）的血管收缩、保盐和肥厚特性与缓激肽的血管舒张和利钠特性之间的平衡，并改变了许多其他血管活性物质的代谢。ACE抑制剂在其活性部分的化学结构、效力、生物利用度、血浆半衰期、消除途径、对组织结合型ACE的分布和亲和力以及是否以前药形式给药等方面存在差异。因此，ACE抑制剂的副作用可分为类特异性副作用和与特定药物相关的副作用。ACE抑制剂可降低全身血管阻力而不增加心率，并促进利钠作用。它们已被证明对治疗高血压有效，可降低心肌梗死后充血性心力衰竭和左心室功能障碍患者的死亡率，并延缓糖尿病肾病的进展。正在进行的研究将阐明ACE抑制剂对原发性高血压患者心血管死亡率的影响、ACE抑制剂在心肌梗死后无心室功能障碍患者中的作用以及与新上市的血管紧张素AT1受体拮抗剂相比ACE抑制剂的作用。
