贝那普利与氨氯地平治疗老年单纯收缩期高血压临床疗效比较

目的比较贝那普利与氨氯地平治疗老年单纯收缩期高血压临床疗效。方法将我院收治的96例老年单纯收缩期高血压患者随机分成两组，A组50例，给予氨氯地平5rag／次，1次／d，晨服；B组46例，给予贝那普利10mg／次，1次／d晨服，均治疗12周。第4周A组根据血压情况调整氨氯地平为10mg／次，1次／d；B组贝那普利为20mg／次，1次／d治疗9周。每周记录血压及不良反应。结果两组患者治疗前、后SBP、PP间差异均有非常显著性意义（P〈0.01）。A组有效率为89．1％，B组有效率为88．5％，两组患者有效率间差异无显著性意义（P〉0.05）。结论氨氯地平与贝那普利降低老年收缩期高血压临床疗效确切，两药降压效果相近，不良反应少，均为有效长效降压剂。     

缬沙坦联用松龄血脉康治疗原发性高血压探讨

目的观察缬沙坦联用松龄血脉康的降压疗效。方法选择我院原发性高血压患者118例，随机分为治疗组印例和对照组58例。对照组患者给予缬沙坦80mg/d，晨8时顿服；治疗组在此基础上给予松龄血脉康胶囊2粒/次。3次／d。疗程均为4周。记录每日血压变化和自觉症状、不良反应。结果两组患者临床疗效闻差异有显著性意义（P〈0．05）。治疗前、后两组患者收缩压、舒张压间差异均有非常显著性意义（P〈0．01），且治疗后两组患者血压间差异亦均有显著性意义（P〈0．05）。结论缬沙坦联用松龄血脉康治疗高血压疗效确切、安全。无明显不良反应。     

苯磺酸左旋氨氯地平治疗糖尿病合并肾性高血压的临床观察

目的观察苯磺酸左旋氨氯地平和得高宁治疗糖尿病合并肾性高血压和尿白蛋白的疗效。方法将我院34例糖尿病合并肾性高血压患者随机分为观察组和对照组各17例,所有患者受试前停用影响肾功能药物及其他降压药物2周。观察组患者在抗糖尿病治疗的基础上给予苯磺酸氨氯地平2．5mg/次,1次/d,如果2周后血压仍未降至正常（140/90mmHg）,则苯磺酸氨氯地平增加至5mg/次,1次/d;对照组患者给予得高宁10mg/次,2次/d,如果2周后血压仍未降至正常,得高宁增加至20mg/次,2次/d。疗程均为12周。结果两组患者治疗前、后收缩压、舒张压间差异均有非常显著性意义（P＜0．01）。观察组患者治疗前、治疗后24h尿蛋白排泄及24h尿蛋白定量间差异均有显著性意义（P＜0．05）,观察组患者治疗前、后尿素氮和血肌酐及对照组患者治疗前、治疗后24h尿白蛋白和24h尿蛋白定量、尿素氮、血肌酐间差异均无显著性意义（P＞0．05）。结论苯磺酸左旋氨氯地平不仅能有效控制糖尿病合并肾性高血压,而且还能减少24h尿白蛋白的排泄。     

联合苯磺酸左旋氨氯地平治疗难治性高血压临床观察

目的观察血管紧张素转化酶抑制剂（ACEI）、β-受体阻滞剂、利尿剂等联合苯磺酸左旋氨氯地平对难治性高血压的临床疗效。方法选择我院难治性．高血压患者76例，随机分为观察组和对照组各38例，对照组患者给予血管紧张素转化酶抑制剂（ACEI）、β-受体阻滞剂、利尿剂等药物联合治疗，观察组患者在此基础上给予苯磺酸左旋氨氯地平片2．5～5．0mg／次，1次／d，疗程均为4周。观察两组患者血压达标率、治疗后血压情况及不良反应情况。结果观察组患者治疗后达标33例（86．8％）对照组患者治疗后达标21例（55．3％），两组患者达标率间差异有非常显著性意义（P〈0．01）。两组患者治疗前、后收缩压（SBP）、舒张压（DBP）间差异均有显著性意义（P〈0．05）；且两组患者治疗后SBP、DBP间差异亦均有显著性意义（P〈0．05）。结论苯磺酸左旋氨氯地平是一个通过拆分技术获得的新药，具有较好的依从性和降压效果，尤其是在治疗难治性高血压方面疗效确切。     

氨氯地平单用或与赖诺普利联用降压疗效比较及对肾保护作用

目的观察氨氯地平单用或与赖诺普利联合应用治疗中老年原发性高血压的降压疗效观察及对肾的保护作用。方法64例中老年原发性高血压患者随机分为氨氯地平组（A组）和氨氯地平加赖诺普利组（B组），分别予以氨氯地平5mg／d口服和氨氯地平加赖诺普利10mg／d口服，比较治疗前和治疗8周后尿微量蛋白及血压。结果降压疗效总有效率A组为53．1％，B组为78．1％，两组比较差异有显著性（P〈0．05）。两组用药后尿微量蛋白水平较前明显降低，与用药前比较及两组间比较差异有显著性（P〈0．05）。结论血管紧张素转换酶抑制剂（ACEI）赖诺普利和钙离子拮抗剂（CCB）氨氯地平联合应用可显著降血压并对肾有保护作用。     

咪达普利治疗慢性心力衰竭疗效观察

目的观察咪达普利治疗慢性充血性心力衰竭（CHF）的临床疗效。方法选择我院CHF患者80例,随机分为治疗组和对照组各40例,两组患者入院后均卧床休息,限盐、积极治疗心衰病因及诱因,并联合应用地高辛0．125～0．250mg/d,消心痛10mg/次,3次/d,倍他乐克12．5～25．0mg/次,2次/d,呋塞米或安体舒通间断使用。治疗组在此基础上加用咪达普利2．5～10．0mg/d,从2．5mg/d开始,如血压稳定,3d后改为5．0mg/d,部分血压偏高患者2周后可增至10．0mg/d,疗程均为3个月。结果两组患者治疗有效率间差异有显著性意义（P＜0．05）。两组患者治疗前、后收缩压（SBP）,舒张压（DBP）、心率、6min步行距离、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVEsDD）、射血分数（LVEF）间差异均有显著性意义（P＜0．05）。结论咪达普利对CHF有较好的疗效,优于常规治疗。     

咪达普利与吲达帕胺联合治疗原发性高血压疗效及对内皮依赖性舒张功能的影响

该文探讨咪达普利与吲达帕胺联合治疗原发性高血压的临床疗效及对内皮依赖性舒张功能（FMD）的影响。方法：采用随机、平行、对照方法，高血压患者307例，分3组：A组（61例）用吲哒帕胺2．5mg，1次／d；B组（118例）用吲哒帕胺2．5mg，1次／d，加美托洛尔25mg，2次／d；C组（128例）用吲哒帕胺2．5mg，1次／d，加咪达普利5mg，1次／d。疗程均为8周。各组治疗2周后若偶测血压仍〉140／90mmHg（1mmHg=0．133kPa）则药物剂量加倍（联合用药组吲哒帕胺剂量不变）。结果：3组高血压患者治疗8周后动态血压监测显示，除A组患者夜间平均收缩压（SBP）和舒张压（DBP）治疗前后差异无统计学意义外，     

抗抑郁治疗对老年高血压降压疗效的影响

该文探讨抗抑郁治疗对老年高血压患者降压疗效的影响。方法：对138例老年高血压合并抑郁的患者随机分为A、B组，并设老年高血压患者对照组103例，3组均给予氢氯噻嗪12．5mg／d和硝苯地平控释片30mg／d口服，A组在此基础上加服氟西汀（百优解）20mg／d口服，共12周；B组给予阿米三嗪（都可喜）1片和谷维素20mg，3次／d，共12周。结果：A组与治疗前及B组相比，其坐位血压、24h动态血压监测昼夜收缩压和舒张压均明显下降，差异有非常显著意义（P〈0.01）。结论：抗抑郁治疗有利于老年高血压合并抑郁患者的血压控制。     

急性脑卒中的降压治疗

目的观察和比较地尔硫卓和赖诺普利在急性脑卒中患者中的降压作用。方法有急性脑卒中的高血压病人105例，根据血压值不同分为3组，A组33例，先给予地尔硫卓针剂50mg溶于0．9％氯化钠注射液或5％葡萄糖注射液250ml中静滴，2～4h滴完。24h后，给予地尔硫卓缓释片剂90mg口服，每13一次，服用二周。B组37例，给予地尔硫卓缓释片剂90mg口服，每日一次，服用二周。C组35例，给予赖诺普利片剂10mg口服，每13一次，服用二周。结果A组病例用药后第14天降压有效率达87．9％，B组86．5％，C组85．7％，3组病例有效率差别无显著意义。A组病例静脉用药后10、20、30、60、120min血压降压幅度（差值）与其前一观察时刻的血压值差别有显著意义，3组病例用药后第1天，第2天，第7天，第14天的血压降压幅度（差值）与其前一观察值差别均有显著意义，B组与C组组间的相应降压幅度差别均无显著意义。A组病例静滴降压安全性达87．9％。所有病例用药后不良反应轻微。结论地尔硫卓和赖诺普利在急性脑卒中患者中的降压作用疗效确切、二者之间无显著差异、安全性高。     

缬沙坦联用养血清脑颗粒治疗原发性高血压60例疗效观察

目的观察缬沙坦联用养血清脑颗粒的降压疗效。方法选择原发性高血压患者118例,随机分为治疗组60例和对照组58例。对照组给予缬沙坦80mg／d,晨8时顿服;治疗组在此基础上给予养血清脑颗粒1包／次,3次／d;疗程均为4周。记录每日血压变化和自觉症状、不良反应。结果两组治疗前后收缩压、舒张压比较差异均有统计学意义（P均〈0．01）,治疗后两组血压比较差异有统计学意义（P〈0．05或〈0．01）。结论缬沙坦联用养血清脑颗粒治疗高血压疗效确切、安全,无明显不良反应。     

Protection of the Cardiovascular System by Imidapril,a Versatile Angiotensin‐Converting Enzyme Inhibitor

Imidapril hydrochloride (imidapril) is a long‐acting, non‐sulfhydryl angiotensin‐converting enzyme (ACE) inhibitor, which has been used clinically in the treatment of hypertension, chronic congestive heart failure (CHF), acute myocardial infarction (AMI), and diabetic nephropathy. It has the unique advantage over other ACE inhibitors in causing a lower incidence of dry cough. After oral administration, imidapril is rapidly converted in the liver to its active metabolite imidaprilat. The plasma levels of imidaprilat gradually increase in proportion to the dose, and decline slowly. The time to reach the maximum plasma concentration (T_max) is 2.0 h for imidapril and 9.3 h for imidaprilat. The elimination half‐lives (t_1/2) of imidapril and imidaprilat is 1.7 and 14.8 h, respectively. Imidapril and its metabolites are excreted chiefly in the urine. As an ACE inhibitor, imidaprilat is as potent as enalaprilat, an active metabolite of enalapril, and about twice as potent as captopril. In patients with hypertension, blood pressure was still decreased at 24 h after imidapril administration. The antihypertensive effect of imidapril was dose‐dependent. The maximal reduction of blood pressure and plasma ACE was achieved with imidapril, 10 mg once daily, and the additional effect was not prominent with higher doses. When administered to patients with AMI, imidapril improved left ventricular ejection fraction and reduced plasma brain natriuretic peptide (BNP) levels. In patients with mild‐to‐moderate CHF [New York Heart Association (NYHA) functional class II‐III], imidapril increased exercise time and physical working capacity and decreased plasma atrial natriuretic peptide (ANP) and BNP levels in a dose‐related manner. In patients with diabetic nephropathy, imidapril decreased urinary albumin excretion. Interestingly, imidapril improved asymptomatic dysphagia in patients with a history of stroke. In the same patients it increased serum substance P levels, while the angiotensin II receptor antagonist losartan was ineffective. These studies indicate that imidapril is a versatile ACE inhibitor. In addition to its effectiveness in the treatment of hypertension, CHF, and AMI, imidapril has beneficial effects in the treatment of diabetic nephropathy and asymptomatic dysphagia. Good tissue penetration and inhibition of tissue ACE by imidapril contributes to its effectiveness in preventing cardiovascular complications of hypertension. The major advantages of imidapril are its activity in the treatment of various cardiovascular diseases and lower incidence of cough compared with some of the older ACE inhibitors.     

Efficacy and safety of imidapril in patients with essential hypertension: a double-blind comparison with captopril

In this 12-week, double-blind, parallel-group, comparative trial, 57 adult patients with mild-to-moderate hypertension were randomly allocated to receive imidapril or captopril, initially at a dose of 5 mg once a day and 25 mg twice daily, respectively. After 4 weeks of therapy, the dose of each drug was increased twice if diastolic blood pressure (DBP) remained > or =90 mm Hg. Both treatments effectively lowered DBP in a comparable manner. Mean changes from baseline in DBP at 12 weeks were -9.9 mm Hg for imidapril and -8.8 mm Hg for captopril (p = 0.488). Responder rates in patients receiving active treatment for at least 6 weeks were 53.9% for imidapril and 48% for captopril (p = 0.676). Both treatments were well tolerated. Adverse drug reactions were observed in 20.7% (6/29) of the imidapril group and 46.4% (13/28) of the captopril group (p < 0.05). A cough was the most frequent side effect, reported in 13.8% of the imidapril group and 35.7% of the captopril group. The results indicate that imidapril is as effective as captopril in the treatment of hypertension. Imidapril produces less adverse effects compared with captopril.     

Long-term Effects of Captopril and Atenolol in Essential Hypertension

ABSTRACT Fifty patients with mild or moderate essential hypertension were randomized (double-blindly) to treatment with either captopril (n=26) or atenolol (n=24). Their mean supine diastolic blood pressure after placebo was 100–125 mmHg. The study included an initial dose finding phase (12 weeks) during which the dosages of captopril and atenolol were increased stepwise every second week in order to obtain normotension (supine diastolic blood pressure <95 mmHg). Hydrochlorothiazide was added when necessary. During the second phase of the study the patients were followed on active treatment for 2 years. After the initial 12 weeks of active treatment, recumbent and standing blood pressures had fallen significantly both in the captopril group (by 31/20 and 33/19 mmHg, p<0.001) and in the atenolol group (by 24/18 and 30/20 mmHg, p<0.01 (systolic), p<0.001 (diastolic)). The antihypertensive effect was maintained in both groups during long-term treatment. The antihypertensive effect of both agents was potentiated to the same extent by addition of hydrochlorothiazide. Side-effects were few and mild. It can be concluded that both captopril and atenolol are safe and effective antihypertensive drugs.     

Effect of long term therapy with captopril on dopplerographic parameters of intrarenal blood flow and renal function in patients with hypertension and diabetes

Effect of 9-12 month treatment with captopril on dopplerographic parameters of intrarenal blood flow and renal function was studied in 30 hypertensive diabetics without clinical signs of nephroangiopathy. There was an interrelationship between strict blood pressure (BP) control (average 24-hour BP below 135/83) and improvement of parameters of intrarenal hemodynamics. BP normalization and most pronounced positive changes of renal perfusion during therapy with captopril were achieved in patients with mild hypertension and initially high intrarenal resistance yet at the stage of normo- or microalbuminuria. In moderate hypertension with microalbuminuria treatment with captopril was associated with stabilization of parameters of renal blood flow and rate of 24-hour albumin excretion at their initial level despite less strict control of BP and unsatisfactory compensation of diabetes. BP response to captopril in patients with hypertension and diabetes was related to initial state of intrarenal hemodynamics. In patients with mild hypertension indexes of resistance of renal and intrarenal arteries could be used for prediction of sensitivity to antihypertensive action of captopril.     

抗高血压药物对轻中型高血压患者糖代谢的影响

采用随机、交叉、双盲设计的前瞻性临床研究,观察国内目前最常用的作用机制迥异的4种抗高血压药物对轻中型高血压患者糖代谢的影响。未经治疗的40例高血压病人,随机分为4组,每组10例,在双盲控制下分别接受一种降压药（卡托普利、尼群地平、普萘洛尔、氢氯噻嗪）及安慰剂治疗各4周。治疗期间观察空腹血糖、糖耐量及运动血糖。结果表明卡托普利、尼群地平在4周中对OGTT及运动血糖值无明显影响（P>0.05）,氢氯噻嗪使30,60,120 min血糖水平增高和运动恢复期血糖水平增高（P<0.05）。普萘洛尔组表现为运动前、运动中及运动恢复早期的血糖水平降低（P<0.05）。     

Antihypertensive effects of captopril and saralasin in essential and renal hypertension

The antihypertensive effect of captopril and its mechanism of action were studied in patients with essential and renal hypertension. In mild essential hypertension (n = 12), during monotherapy with captopril (50 to 450 mg, 4 to 12 weeks) blood pressure was normalized in seven, improved in two and remained unchanged in three patients, plasma levels of active and acid-activatable inactive renin significantly increased and angiotensin II decreased, whereas no consistent changes in urinary kallikrein excretion occurred. In severe renal (n = 14) and essential (n = 9) hypertension, blood pressure was normalized in eight (seven with renal hypertension), improved in seven and unchanged in eight patients, when captopril (50 to 450 mg, 3 to 15 months) was added to the antihypertensive medication. In one patient with stenosis in a transplanted renal artery reversible renal failure occurred during captopril therapy possibly because of a steep initial decrease in blood pressure, although a toxic effect of the drug cannot be excluded. In another series of 12 renal and 8 essential hypertensive patients, a significant correlation between the acute effect of captopril (within 90 minutes) and saralasin on blood pressure was demonstrated (r = 0.71, p < 0.001). The change in blood pressure after either drug was significantly related to the initial plasma renin concentration.In conclusion, captopril sems to be an effective antihypertensive agent in essential and renal hypertension. Renal function should be monitored during captopril therapy. Our studies suggest that captopril decreases blood pressure by inhibiting the vasopressor action of the renin-angiotensin system.     

阿罗洛尔、咪唑普利和依那普利治疗原发性高血压疗效观察(附24小时动态血压结果分析)

目的 评价阿罗洛尔、咪唑普利、依那普利对24 h血压的降压效果。方法 轻、中度原发性高血压患者60例,采用随机区组法分为三组,每组20例,使用24 h动态血压监测方法对阿罗洛尔(20-30mg/d)、咪唑普利(5-10mg/d)及依那普利(5-1Omg/d)降压疗效进行为期六周的对比现察。结果 三种药物对诊室血压均有明显降压效果(P<0.001),组间无明显差别(P>0.05)。动态血压结果显示三种药物均有明显降低动态血压的效果(P<0.05),阿罗洛尔组降低24 h平均血压及白天平均血压幅度比其它两组大(P<0.05)。三种药物的谷/峰比值均大于50%。治疗前后的血压曲线,阿罗洛尔组呈完全分离状态,咪唑普利组、依那普利组均有交叉重叠现象,依那普利组重叠点较多。结论 阿罗洛尔对控制白天血压较为理想,长效制剂咪唑普利能平稳地控制24 h血压。     

Sexual symptoms in hypertensive patients. A clinical trial of antihypertensive medications

The effects of captopril, methyldopa, and propranolol hydrochloride on reported distress over sexual symptoms over a 24-week treatment period were examined as part of a multicenter, randomized, double-blind clinical trial in which 626 men with mild to moderate hypertension participated. On entry into the clinical trial, 58% of patients taking antihypertensive medications and 44% of men not receiving antihypertensive drugs reported distress over one or more sexual symptoms. Among 304 patients treated with monotherapy who completed the trial, total symptoms distress scores of treatment groups did not differ from each other in change from baseline to week 24, but in particular, problems of maintaining an erection were significantly worsened with propranolol therapy. Among 177 patients treated with monotherapy plus a diuretic, total sexual symptoms distress scores worsened among the groups taking methyldopa or propranolol, with significant worsening in all individual symptoms among patients taking propranolol, and problems in maintaining an erection and in ejaculation among patients receiving methyldopa. Among patients treated with captopril plus a diuretic, no change from baseline appeared in scores for any of the sexual symptoms. The findings underline the importance of taking an adequate sexual history and document that selection of antihypertensive drugs may significantly affect the incidence of sexual symptoms.     

卡托普利与美托洛尔治疗轻、中度高血压疗效比较

本文比较了血管紧张素转换酶抑制剂卡托普利（开搏通）与选择性β１受体阻滞剂美托洛尔（倍他乐克）治疗轻中度高血压即时和短程疗效。眼药后１ｈ，卡托普利组收缩压和舒张压明显下降（Ｐ＜０．０１），而美托洛尔组仅收缩压下降（Ｐ＜０．０５）。服药后３ｈ，两药均达最大降压疗效，两组降压比较无统计学差异。服药后１２ｈ美托洛尔组收缩压和舒张压仍有降压作用（Ｐ＜０．０５），而卡托普利仅对舒张压有作用（Ｐ＜０．０５）。服药后２１天，卡托普利和美托洛尔组总有效率分别是８７．５％和８３．３％（ｘ２＝４．２２，Ｐ＞０．０５）。     

Effect of enalapril in patients with essential hypertension

In a randomized, blind trial, enalapril and captopril were compared in 479 patients with essential hypertension. The results showed that both enalapril and captopril had similar effects on the blood pressure. The response rate was 77.8% with enalapril and 70.4% with captopril. Blood pressure lowered 2.68/1.59 kPa (20.1/11.9 mmHg) in enalapril group versus 2.44/1.43 kPa (18.3/10.7 mmHg) in captopril group. No serious side effects were observed and both enalapril and captopril were well tolerated. Thus, enalapril and captopril appear equally effective and safe in patients with essential hypertension and enalapril is better accepted by patients because of its longer duration of antihypertensive activity.