Evaluation of renal function in elderly heart failure patients on ACE inhibitors

A total of 187 heart failure patients aged 65-92 years, with pretreatment serum creatinine levels below 200 µmol/l, were monitored for more than 12 months on angiotensin-converting enzyme (ACE) inhibitor therapy. Optimal ACE inhibitor dosage was found in 27% of patients, while a significant deterioration in renal function, characterised by >20% increase in serum creatinine to >200 µmol/l, occurred in 25 patients. This was most closely attributable to ACE inhibitor treatment per se (implying co-existence of bilateral renal artery stenosis) in only four cases, including one in whom renal deterioration was reproducible on inadvertent rechallenge. In the other 21, renal deterioration was attributable to diuretic-related blood volume depletion (two cases), nonsteroidal anti-inflammatory drugs (two cases), obstructive uropathy (two cases), preterminal renal shutdown (two cases), and the interaction between diuretic and ACE inhibitor dosage (including long-acting vs short-acting drugs) (13 cases). This study could serve as the basis for future comparisons of ACE-inhibitor-related renal deterioration when the entry requirement is optimal ACE inhibitor dosage.


     

卡维地洛对充血性心衰患者心脏功能的影响

将符合本试验纳入标准的88例充血性心衰患者分成试验组（40例）和对照组（48例），患者均口服地高辛、血管紧张素转换酶抑制剂制剂、血管扩张剂（非钙离子拮抗剂）和利尿剂等基本抗心衰药物，在此基础上试验组加服卡维地洛。随访7个月后，复查心脏彩超心脏射血分数和左室短轴缩短率，与试验初比较两组均有显著的改善，而服药7个月后试验组较对照组有显著的升高（P＜0.05)。表明卡维地洛可使心肌重塑过程得到缓解，还可以更显著地改善心功能。     

ACE inhibitors and beta blockers in chronic congestive cardiac failure: therapeutic basis

Congestive cardiac failure (CCF) is a common problem through out the globe and is associated with high morbidity and mortality. The rapid progression of the disease due to neurohormonal activation can be blunted by use of angiotensin-converting enzyme inhibitor (ACEI) and beta blockers (BB) with a major impact on morbidity and mortality. Besides CCF, they are also useful in asymptomatic left ventricular dysfunction (LVD) and in prevention of heart failure in high risk patients without LVD. Both ACEI and BB are highly underutilised therapy in CCF and there is an urgent necessity to spread message among the medical fraternity for their enhanced use.     

芪苈强心胶囊治疗慢性心力衰竭

目的：探讨芪苈强心胶囊对慢性心力衰竭（CHF）的临床效果。方法选取70例 CHF 患者,随机分为治疗组和对照组,各35例,对照组给予卧床、吸氧及应用 ARB 或 ACEI 类、β-受体阻滞剂、利尿剂等药物治疗,治疗组在对照组基础上加用芪苈强心胶囊,4粒/次,3次/ d,均连续治疗3个月,对比2组治疗前后左室舒张末内径（LVEDD）、左室射血分数（LVEF）、6 min 步行试验（6MWT）、血浆 N 端前脑钠肽（NT-proBNP）、血浆抗利尿激素（ADH）水平及临床疗效。结果治疗组治疗后 LVEDD 减小程度及 LVEF、6MWT 增加程度,优于对照组（P ﹤0.05）;治疗组治疗后 NT-proBNP、ADH 水平下降程度优于对照组（P ﹤0.05）;治疗组总有效率为94.3℅,明显优于对照组的77.1℅（P ﹤0.05）。结论芪苈强心胶囊可明显改善 CHF 患者临床症状,具有增强心肌收缩力,改善血流动力学,抑制肾素—血管紧张素—醛固酮系统（RAAS）,延缓和阻止心肌重构作用。     

自拟强心汤治疗慢性心力衰竭疗效观察

目的探讨自拟强心汤治疗慢性心力衰竭的临床效果。方法将60例慢性心力衰竭患者随机分为观察组和对照组,对照组给予常规西药治疗,观察组在对照组的基础上给予自拟强心汤治疗,观察两组患者的临床症状及心功能改善情况。结果两组患者治疗后与治疗前相比,症状及心功能均得到改善,观察组患者的有效率高于对照组,经统计学分析,差异有统计学意义(P<0.05)。结论在常规西药治疗的基础上加用自拟强心汤,可以显著改善慢性心力衰竭患者的临床症状,提高心功能,自拟强心汤具有较高的临床应用价值。     

阿魏酸钠治疗慢性心功能不全的疗效观察

目的：观察阿魏酸钠治疗慢性心功能不全的临床效果。方法：64例慢性心功能不全患者分为治疗组和对照组,治疗组在常规治疗基础上加用阿魏酸钠治疗2个疗程;对照组在常规处理基础上加用维生素C治疗2个疗程,观察两组患者心功能不全症状缓解情况以及左室功能改善情况。结果：治疗后,治疗组有效率为87.5%、对照组有效率为65.6%,两组比较有显著差异（P〈0.05）;治疗组左室EF值为61%、对照组左室EF值为50%,两组比较有显著差异（P〈0.05）。结论：慢性心脏功能不全患者在常规治疗基础上加用阿魏酸钠可进一步改善心脏功能。     

心力衰竭患者心肌组织ACE2和ACE基因表达

目的 观察心力衰竭(简称心衰)患者不同心功能状态下血管紧张素转换酶2(angiotensin converting enzyme, ACE2)和ACE基因表达变化,探讨其与心衰患者心功能的关系.方法 通过手术取材,采用RT-PCR技术检测30例瓣膜病所致不同程度心衰患者和5例正常人心肌组织中ACE2和ACE mRNA表达.结果 瓣膜病所致心衰患者心肌组织ACE2和ACE mRNA表达均较正常组明显升高(P＜0.01),其中中重度心衰患者升高尤为显著(P＜0.01).轻度心衰患者心肌组织ACE2/ACE mRNA比值较正常组升高,中重度心衰时ACE2/ACE mRNA比值下降.结论 心衰患者心肌组织ACE2和ACE基因表达明显增强.轻度心衰患者ACE2/ACE mRNA比值升高可能是心脏的代偿机制,促进AngⅡ降解,增加Ang1-7合成,保护残存的心功能.中重度心衰患者ACE2/ACE mRNA比值降低,引起AngⅡ过度激活,加速心衰恶化.     

促红细胞生成素在慢性心力衰竭中的应用进展

慢性心力衰竭(CHF)是各种心脏病导致心功能不全的一种综合征,一旦出现CHF,大部分患者病情均会进行性恶化.促红细胞生成素(EPO)作为一种调节红细胞生成的内分泌激素,近年来已用于CHF患者的贫血治疗并且明显改善预后.本文就此做一综述.     

卡维地洛治疗慢性心力衰竭的临床观察

目的 观察卡维地洛治疗慢性心力衰竭(心衰)的疗效及其安全性.方法 将98例慢性轻、中度心衰患者作为研究对象,随机分为治疗组和对照组.治疗组50例,在心衰标准用药的基础上,卡维地洛由小剂量开始,逐渐递增至目标剂量,治疗12wk;对照组48例,仅用心衰标准用药治疗12wk.结果 治疗组在减慢心率、改善心功能等方面均优于对照组,总有效率分别为82%和62.5%,两组间有显著性差别(P＜0.05);治疗组多见的不良反应为头晕,但其发生率与对照组比较,差异无显著性;两组均未发生血尿常规、电解质、糖代谢改变及肝、肾功能损害.结论 在常规抗心衰治疗的基础上加用卡维地洛是有效和安全的.     

卡维地洛治疗慢性充血性心力衰竭的临床研究

目的研究卡维地洛治疗慢性充血性心力衰竭 (CHF)的临床疗效及安全性。方法 96例CHF患者随机分为 2组 ,卡维地洛在对照组治疗的基础上 ,加服卡维地洛 ,对照组采用常规治疗方法 (ACEI、利尿剂、地戈辛 )。治疗 3个月后 ,评价心功能 ,检查超声心力图 2次 (治疗前后 )。检查治疗前后肝、肾功能。结果卡维地洛治疗组显示心功能明显改善 (p <0 .0 5 ) ,左心室射血分数明显增加 (p <0 .0 5 ) ,未发现肝、肾功能恶化。结论卡维地洛在常规治疗CHF的基础上 ,对CHF患者安全有效 ,可作为CHF的常规治疗。     

缬沙坦和美托洛尔治疗慢性心力衰竭疗效观察

目的 观察缬沙坦和美托洛尔治疗慢性心力衰竭疗效.方法 296例慢性心力衰竭患者,随机分为治疗组和对照组,治疗组在基本治疗基础上加缬沙坦和美托洛尔,缬沙坦20～80mg,一日一次.美托洛尔6.75mg～75mg,一日两次.结果 治疗组有效率96.18%,对照组有效率87.68%,两者对比差异有显著性(P≤0.05),左室射血分数、心率、左室舒张末期内径、药前后对比有显著差异(P≤0.01).结论 缬沙坦和美托洛尔治疗慢性心力衰竭有效.     

A survey of the dose of ACE inhibitors prescribed by general physicians for patients with heart failure

AIM—To describe the pattern of angiotensin converting enzyme (ACE) inhibitor doses prescribed by general physicians for patients with chronic heart failure and to review the current evidence favouring the use of higher doses.
DESIGN—A retrospective survey of the medications of 125 patients with chronic heart failure (in both inpatient and outpatient settings) was carried out between December 1999 and February 2000.
RESULTS—Altogether 18.4% of patients surveyed were receiving no ACE inhibitor, the majority of these (65%) having a contraindication to such an agent. Of those patients who were prescribed an ACE inhibitor, 65% were receiving a high dose. The majority of patients who were prescribed a low dose of ACE inhibitor had no identifiable contraindication to receiving a higher dose. Of all patients with chronic heart failure studied, 25% were receiving either no ACE inhibitor or only a low dose in the absence of contraindication.
CONCLUSION—Since no objectively measurable variable has been shown to share a clear relationship with the outcome benefits of ACE inhibitors, no convenient and reliable assessment exists for determining when an adequate dose has been reached for each patient. There is an abundance of evidence favouring high dose ACE inhibitors in heart failure; evidence for the role of low doses is much less clear. The fact that only half of the patients with chronic heart failure were found to be receiving a high dose of ACE inhibitor is probably testimony to inaccurate perceptions and unreliable assumptions among physicians. It is likely that a change in current prescribing patterns would benefit patients with chronic heart failure.


     

β受体阻滞剂治疗慢性心力衰竭30例临床分析

目的：观察在常规药物治疗基础上加用β受体阻滞剂治疗慢性心力衰竭的临床疗效。方法选择30例心力衰竭患者以滴定法的治疗策略使用β受体阻滞剂,并以心脏超声检查和6 min步行距离来客观评价临床症状和心功能改善情况。结果为期2年的治疗后观察患者临床症状好转、心脏缩小和心功能改善（P<0.01）。结论针对社区或基层的慢性心力衰竭患者应尽早积极使用β受体阻滞剂,以达到改善症状和心功能的目的。     

心脉隆注射液治疗慢性心力衰竭的临床研究

【目的】观察心脉隆注射液对慢性心力衰竭（chronic heart failure,CHF）患者中心静脉压（CVP）、心脏左室射血分数（LVEF）、B型利钠肽（BNP）的影响。【方法】选择2008年9月-2009年9月住院治疗的CHF患者243例（NYHA心功能分级Ⅳ级）,按其是否使用心脉隆注射液分为心脉隆治疗组及常规药物治疗对照组。【结果】治疗2周后心脉隆治疗组LVEF、CVP及BNP水平低于对照组,差异有统计学意义（P〈0.05）,症状明显改善,且用药过程中无明显副作用发生。【结论】心脉隆注射液可降低CHF患者心脏负荷,抑制神经内分泌激活,显著改善心功能。     

氨氯地平治疗慢性心功能不全的临床观察

目的:评价氨氯地平治疗慢性心功能不全的疗效与安全性。方法:将60例慢性心功能不全患者随机分为治疗组和对照组各30例,对照组以利尿剂、洋地黄及血管紧张素转换酶抑制剂等类药物常规治疗。治疗组在此基础上,加用苯磺酸氨氯地平片(洛活喜)5～10mg/d,比较两组血压、心率、LVEF(左室射血分数)、LVDd(左室舒张末内径)、尿常规、电解质等指标变化。结果:治疗4周后两组心功能均有改善,LVEF升高,LVDd降低,血压下降,心率降低。治疗前后比较,差异有显著性(P<0.05);与对照组相比,治疗组LVEF升高及收缩压下降的幅度更显著(P<0.01)。两组患者在治疗期间尿常规、电解质、肝功能、肾功能均无明显改变。结论:治疗剂量的氨氯地平是治疗慢性心功能不全较为理想的药物。     

The use of angiotensin-converting enzyme inhibitors in the treatment of heart failure in hospital practice.

Several well-controlled trials in patients with heart failure have shown that the use of angiotensin-converting enzyme (ACE) inhibitors, in combination with a diuretic, causes a reduction in mortality and morbidity, which seems to be mainly due to a reduction in fatal and nonfatal cardiovascular events. Our aim was to determine whether 249 consecutive patients discharged from hospital with a primary diagnosis of heart failure were routinely being treated with an ACE inhibitor at an appropriate dose. At the time of admission to hospital, 91 (36.5%) were receiving a combination of a diuretic and an ACE inhibitor, 129 (51.8%) were receiving a diuretic alone, and 29 (11.6%) had not previously received either a diuretic or an ACE inhibitor. At the time of discharge from hospital all patients were on a diuretic and 144 (57.8%) were also receiving an ACE inhibitor. Although 41 patients (16.5%) had a relative or absolute contraindication for the use of an ACE inhibitor, 64 patients (25.7%) with no contraindication were not receiving an ACE inhibitor. Many of the patients who were prescribed an ACE inhibitor were given it at an inappropriate dose; only 24 patients (16.7%) were on the dose that was used in the clinical trials showing a reduction in mortality. These results show that in one in four patients admitted to hospital with heart failure who should be receiving an ACE inhibitor by the time of discharge, are not. The average age of these patients was 76 years. Whilst it has been shown that the benefit of ACE inhibitors does not appear to be age-related, most published studies have not included many patients over the age of 80. Specific studies looking at the effect of ACE inhibitors in elderly patients would be helpful, as well as studies to determine the optimum treatment regimen for this age group.