A Long-term Follow-up of Patients with Essential Hypertension Treated with Captopril

Abstract Seventy-four patients from four short-term studies of captopril in mild-moderate essential hypertension continued in a cooperative long-term efficacy and tolerance program. The duration of observation is 2–>4 years, the total treatment time being 2434 months. No development of resistance to therapy was observed. The total daily dose of captopril has been gradually decreased and in 20 patients changed from t.i.d. to b.i.d. regime. The drug has been well tolerated and only few and mild side-effects have been observed after the initial titration period. The drop-outs (n=19) were mostly due to non-medical causes (n=14). Except for one case of proteinuria, no laboratory abnormalities were detected and there were no signs of long-term toxicity.     

The Effects of Twice Daily Captopril and Once Daily Enalapril on Ambulatory Intraarterial Blood Pressure in Essential Hypertension

Intraarterial ambulatory pressure (AP) was recorded before and during therapy with captopril or enalapril in two groups with hypertension. Seven patients were admitted during the study. The. monitoring of AP and heart rate (HR) was performed during placebo therapy and following a minimum period of 7 days of 25 mg twice daily captopril or 2.5 to 10 mg once daily enalapril. The AP and HR following percutaneous insertion of a cannula into the brachial artery were sampled then data were analyzed as reported previously.

After the cannula was inserted, examinations of tilt-up, handgrip and ergometer were performed. Both drugs produced a significant reduction of ambulatory AP throughout 24 hours with preservation of the overall shape of the circadian curve. The results also demonstrated that both drugs had not affected normal daily activities. Thus, twice daily captopril and once daily enalapril can be used as the first-line therapy of hypertension.     

几种降压药物综合疗效随机双盲研究—511例报告

背景有据医学的新模式提出随机双盲对照是评价药物效果的金标准，许多新一代降压药物国内外均少随机双盲研究，本研究采用随机双盲法对常用三类药物的降压效果，安全性，副作用进行评价，为临床医师提供重要参考资料。方法采用随机双盲并行研究，经二周安慰剂洗脱后，５１１例高血压患者分入三组：尼群地平组１７２例，２０ｍｇ／ｄ～３０ｍｇ／ｄ；氨酰心安组１６８例，２５ｍｇ／ｄ～５０ｍｇ／ｄ；卡托普利组１７１例，５０ｍｇ／ｄ～７５ｍｇ／ｄ，观察６月。结果各组３月时降压达峰值，六月时收缩压均有轻微回升，而舒张压持续降低。尼组降压达标率（＜１４０ｍｍＨｇ／９０ｍｍＨｇ）为６５．２％，氨及卡组为５０．８％，４８．４％。撤药率卡组达９．１％，尼、氨组均为５．６％。各组副作用累计发生率相似，卡组咳嗽高达３６．２％，尼组面红２６．１％，氨组乏力２６．３％。氨组生活质量改善最佳。卡组对认知有轻度负面影响，尼组对生活质量总体有轻微负面影响。结论三种药物均可有效降压，尼群地平的综合降压效果优于氨酰心安、卡托普利。氨组生活质量最佳。     

卡托普利对高血压高胰岛素血症的干预

通过对42例原发性高血压患者（EH）、26例正常人测定口服葡萄糖耐量试验（OGTT）前后血糖（GS）、血胰岛素（IS）及其反应曲线下面积，发现EH组空腹GS与对照组之间无统计学差异；空腹IS和服糖后EH组GS、IS及其曲线下面积显著高于对照组，提示EH患者存在糖耐量降低、IS抵抗（IR）。EH组中21例患者单纯接受卡托普利有效降压4～8周后，OGTT显示糖负荷1h、2h的IS和GS水平均显著低于治疗前水平，结果提示卡托普利可以改善EH患者IR。     

卡托普利与小剂量氢氯噻嗪合用治疗高血压疗效观察

目的：研究卡托普利与小剂量氢氯噻嗪合用对高血压患者的疗效及对代谢的影响。方法：５０例原发性高血压患者随机分为两组,第１组：单用卡手早１２．５ｍｇ～７５ｍｇ,每日２～３次。第２组,卡手早１２．５ｍｇ,每日２次,加服氢氯噻嗪１２．５ｍｇ,每日１次,两组治疗时间均为８周,测定治疗前后的基础血压,空腹血糖、血脂、血、血 到、 纱氮、肌酐以及有后的２４小时动态血压。 托普利加小剂量氢氯噻嗪组的总有效率及２４     

苯那普利与卡托普利治疗轻中度原发性高血压疗效对比

目的比较苯那普利与卡托普利对轻中度原发性高血压的降压效应与安全性。方法８４例轻中度原发性高血压患者随机接受苯那普利（１０～２０ｍｇ／ｄ）和卡托普利（３７．５～７５．０ｍｇ／ｄ）（各４２例）治疗４周，其中４４例（每组２２例）于治疗前后行２４ｈ动态血压监测。结果苯那普利和卡托普利的降压总有效率在偶测血压监测时分别为９２．５％和９０．５％（Ｐ＞０．０５），而动态血压监测时两药有效率分别为９５．５％和６３．６％（Ｐ＜０．０５）。结论苯那普利对轻中度原发性高血压疗效较好而且安全。     

依那普利与卡托普利对原发性高血压降压疗效的动态血压观察

对50例轻、中度高血压（EH）患者用依那普利（5mg，4／d）和卡托普利（2.5mg，2／d）口服做单盲平等两组对照研究。治疗4周结果两组总有效率相似（分别60.6％，65.2％，P＞0.05），无论SBP和DBP均值的下降均明显（P＜0.05～0.001）。但对每组各抽5例的24h动态血压监测治疗前后比较，依那普利组24h血压控制均较满意，而卡托普利组白天血压控制满意，但夜晚又翌晨血压与治疗前接近（P＜0.05）。如昼夜血压均高者，选用依那普利等长效制剂为佳，如夜间血压正常者，可用卡托普利治疗，唯晨剂应在睡醒后即服为宜。     

卡托普利,硝苯地平单用或联用治疗高血压的疗效比较

监测单用或合并使用卡托普利和硝苯地平在高血压治疗中的作用。方法２５３例高血压病患者随机分成３组，其中卡托普利组８３例（ＩＳＨ７例），平均用药量９０．１７±１９．５３ｍｇ／ｄ，总有效率７３．５％；硝苯地平组７９例（ＩＳＨ７例），平均用药量３６．３５±１１．４２ｍｇ／ｄ，总有效率７４．７％；卡托普利＋硝苯地平组９１例（ＩＳＨ９例），平均用药量卡托普利４９．３８±１０．３４ｍｇ／ｄ，硝苯地平２２．３６±８．０３ｍｇ／ｄ，总有效率９２．３％。卡托普利＋硝苯地平组疗效均优于前２组（Ｐ均＜０．０１）。３组不良反应发生率分别为３４．９％，５３．２％，１９．８％，以卡托普利、硝苯地平联合组为最低，卡托普利组次之。     

Additive Effects of Moderate Dietary Salt Reduction and Captopril in Hypertension

ABSTRACT In a randomized, cross-over study 27 patients had diastolic blood pressure of ≥ 96 mmHg during four visits without treatment. Following captopril 25 mg b.i.d. nine patients' blood pressure was ≤ 90 mmHg. The remaining 18 were randomized into two treatment modalities, captopril and moderate dietary salt reduction, and captopril and hydrochlorothiazide 25 mg daily. Following a wash-out period the groups crossed over to the alternative treatment. At the end of the control period the average blood pressure was 151/100 ± 12/6 mmHg recumbent and 140/91 ± 11/7 standing, following captopril 144/94 ± 13/5 and 132/92 ± 12/6, respectively, with low salt diet addded to captopril 140/91 ± 12/6 and 128/89 ± 11/6 and with hydrochlorothiazide and captopril 133/86 ± 12/7 and 120/84 ± 11/7 mmHg supine and erect, respectively. It is concluded that moderate dietary salt reduction, which is easily advised, will significantly potentiate the blood pressure fall following captopril treatment in moderate arterial hypertension.     

卡托普利对高血压冠状动脉壁肥厚和储备力下降的预防作用

目的研究卡托普利对高血压冠状动脉壁肥厚和储备力下降的预防作用。方法４ｗ大鼠设３组：分别为自发性高血压大鼠（ＳＨＲ）组、ＳＨＲ口服卡托普利组（ＳＨＲ＋Ｃ）和正常血压大鼠（ＷＫＹ）组,饲养１２ｗ。结果ＳＨＲ＋Ｃ组较ＳＨＲ组,收缩压、冠状动脉壁横截面积、横截面积与内径比及中层血管平滑肌细胞宽度显著下降,最大冠状动脉流量增加,与ＷＫＹ组无显著差异。结论卡托普利能完全预防ＳＨＲ冠状动脉壁肥厚和储备力下降。     

Renal Haemodynamics and Comparative Effects of Captopril in Patients with Benign- or Malignant-Essential Hypertension,or with Chronic Renal Failure

Effects of captopril on arterial pressure (AP) and renal function were investigated in patients with non-malignant “benign” or malignant phase essential hypertension (EH group), or with chronic renal failure (CRF group). After captopril administration, AP and renal vascular resistance (RVR) decreased significantly, and renal blood flow (RBF) and plasma renin activity (PRA) increased in both groups. Glomerular filtration rate (GFR) increased in the EH group, but was unchanged in CRF. Filtration fraction decreased in the malignant hypertension and CRF groups. Significant correlations were found between baseline PRA and baseline RVR, and the captopril-induced decrease in mean AP, decrease in RVR, increase in RBF, and increase in GFR in the EH group, while these associations were not observed in CRF. These results indicate that the high AP, RVR, suppressed RBF and GFR in the EH group were closely related to activity of the renin-angiotensin system, but not so the low RBF and GFR in CRF. Small doses of captopril may improve impaired renal function in EH, and may not cause deterioration in the CRF group.     

Twenty-four hour Blood Pressure Monitoring in the Evaluation of once daily Treatment of Essential Hypertension with Captopril

A new ambulatory blood pressure monitoring system is being used in a study of once daily treatment of essential hypertension with captopril. The Instruments for Cardiac Research system consists of a small, battery powered monitoring device carried by the patient and a base unit containing a microcomputer.

On completion of the 24-hour monitoring schedule, the base unit extracts the data from the portable unit. The base unit can then display the data in tabular or graphic form on its printer, or record it on a built in microcassette recorder. The data can readily be transferred to a main frame computer for subsequent analysis.

Ninety-eight percent of the patients wore the unit initially with only an additional 2% refusals at 3 subsequent evaluations during the 5 month trial. Eighty-six percent of the tapes had one-half or more of the readings.     

氨氯地平和卡托普利联合治疗顽固性高血压的临床疗效观察

观察氨氯地平与卡托普利对顽固性高血压的联合治疗作用。方法高血压Ⅱ～Ⅲ期病人４２人，入选前停药两周，经卡托普利１２．５ｍｇ３／ｄ，２周后ＤＢＰ＞９５ｍｍＨｇ者随机分成２组，分别加服氨氯地平和安慰剂，４周为一个疗程。结果在卡托普利基础上加服氨氯地平使平均ＳＢＰ从１７４降至１４８ｍｍＨｇ。平均ＤＢＰ从１０５降至９２ｍｍＨｇ（Ｐ＜０．００１），安慰剂纠正的氨氯地平降压作用ＳＢＰ降低２２ｍｍＨｇ，ＤＢＰ降低１２ｍｍＨｇ（Ｐ＜０．０１）。结论氨氯地平与卡托普利合用可用于治疗顽固性高血压。     

人群三年降压治疗的疗效观察

目的 对比观察4种降压药物联合方案长期治疗原发性高血压病(EH)的疗效。方法 选择EHⅡ期、Ⅲ期患者892例，按入选顺序分为4组：A组为尼群地平加卡托普利，B组为尼群地平加氨酰心安，C组为硝苯地平加卡托警利加双氢克尿噻，D组为复方降压片，各种原因退出以上4组的为E组；在治疗前后检测血压、血尿常规、肾功髓、24小时尿蛋白、眼底检查及心脏B超。部分患者检测了神经内分泌因子。结果 在治疗后1、3年，5组患者动辣血压均较治疗前明显下降；LVMI和A／E比值均下降，CO和LVEF无变化，血BUN、Cr无变化；各组间无统计学差异。其中A、B、C组的24小时尿蛋白、血尿酸明显下降，眼底情况明显改善，而D、E组则反之；心脑血管疾病死亡例数D、E组明显高于A、B、C组。结论 坚持长期降压治疗可明显减少高危患者的病死率和并发症，并保护其靶器官受损，制定合、理、安全、有效、经济的降压方案对EH患者的管理率、服药率、控制率都有着重要的临床价值和社会意义。     

Long Term Therapy by Captopril in Children with Renal Hypertension

We report on 29 treatment courses in 25 children aged 1.5 – 18 years who received captopril because of severe renal hypertension. The mean initial dosage was 1.3 (0.5 to 3) mg/kg/day and the mean sustaining dose 2.2mg/kg/day. The treatment was followed for 2 – 40 (mean 15) months. We observed a lowering of both systolic and diastolic blood pressure (BP) from 26% at the 2nd day to 65% at the 6th month. The isolated use of captopril was ineffective in 13% of cases, but blood pressure dropped in all of them after addition of beta blocking agents. No clear-cut relation was found between response of blood pressure and etiology, degree of HT or plasma renin activity (PRA). No side effects occurred during treatment except for one case of reversible acute renal failure in a transplanted patient with renal artery stenosis.     

血浆儿茶酚胺含量与老年高血压患者室性心律失常的关系

观察老年期与老年前期高血压患者心律失常的发生及与血浆儿茶酚胺（CA）含量的关系。结果表明，老年期高血压患者室性心律失常的发生率较老年前期显著增多；血浆去甲肾上腺素（NE）、肾上腺素（E）含量较老年前期显著增高；血浆NE含量与24h室性早搏（VPC）总数显著正相关（r=0.356，P＜0.01）。经卡托普利治疗后，血浆NE，E含量均显著下降．室性心律失常的发生率显著降低。本文提示，交感─肾上腺素系统活性增强是引起老年高血压患者室性心律失常的重要因素。     

Converting Enzyme Inhibition in Mild and Moderate Essential Hypertension: I. Acute Effects on Blood Pressure,the Renin-Angiotensin System and Blood Bradykinin after a Single Dose of Captopril

ABSTRACT. The acute effects of 25 mg captopril on blood pressure, heart rate, components of the renin-angiotensin system and blood concentration of bradykinin were followed in a single-blind placebo study of untreated (group A, n = 15) and thiazide-treated (group B, n = 13) patients with mild or moderate essential hypertension. A drug-related fall in blood pressure was seen in both groups. The blood pressure reduction was more marked in group B than in group A. Heart rate remained unchanged. Plasma concentrations of angiotensin II decreased significantly with concurrent increases in plasma concentrations of renin and angiotensin I, indicating the in vivo inhibition of converting enzyme. Blood concentrations of bradykinin showed no systemic changes. The magnitude of blood pressure reduction was correlated both with the pretreatment levels and the concurrent decreases in plasma angiotensin II. Inhibition of angiotensin II formation can explain a large part of the acute hypotensive pharmacological action of captopril. Other vasoactive systems may be involved. The kallikrein-kinin system does not appear to participate as indicated by the unchanged concentrations of kinin in blood.     

佩尔地平,卡托普利单独与联合应用对血压,血流动力学及左室重构影响

目的 佩尔地平为新一代钙拮抗剂卡地平缓释剂,由于降压效果确切平稳,作用时间长,耐受好,对血脂,血糖我不良影响并为唯一可经胃肠道外给药的二氢吡啶类。本文采用随机对照研究评价 地平单独及联合卡托普利的降坟效果和对血流动力学与左室重构影响。方法采取随机,并行研究观察９０例男女高血压、年龄５０岁－７９岁,随机分入佩尔地平组（３０例）卡托普利组（３０例）,佩＋卡组－２７．８ｍｍＨｇ／－１２．０ｍｍＨＧ,卡     

卡托普利对高血压患者血液流变学的影响

对照观察60例高血压患者和24例正常人血液流变学。结果显示35例患者（58．3％）血液流变学异常，表现为全血粘度、血浆粘度、红细胞聚集指数和红细胞压积增高、红细胞电泳时间延长；另25例患者（41．7％）血液流变学正常。卡托普利降压治疗后显效29例（48．3％），有效13例（21．6％），总有效率70％。卡托普利维持有效降压治疗113±11（3～4月）后，血液流变学异常患者各项指标均明显改善，对血液流变学正常患者则无影响。     

培哚普利与卡托普利治疗老年原发性高血压的疗效比较

目的：比较培哚普利与卡托普利对老年原发性高血压的降压效应与安全性。方法：６０例老年原发性高血压患者随机分组接受培哚普利（４～８ｍｇ／ｄ）和卡托普利（３７．５～７５．０ｍｇ／ｄ）（各３０例）治疗４周。结果：培哚普利和卡托普利的降压总有效率偶测血压分别为９０．０％和８６．７％（Ｐ＞０．０５），动态血压监测分别为９５．０％和６５．０％（Ｐ＜０．０５）。结论：培哚普利治疗老年原发性高血压有效而安全，降低夜间舒张压优于卡托普利。