培哚普利和依那普利治疗心力衰竭首剂低血压反应差异的临床研究

目的检验关于“并非所有血管紧张素转换酶抑制剂在开始应用时均引起低血压反应”的假设。方法多中心的随机开放药物平行对照试验。281例经选择的充血性心力衰竭患者（NYHAⅡ～Ⅳ级）随机接受首剂培哚普利2mg（n=144）或依那普利2.5mg（n=137）。基线时，服药后10h内每0.5h测血压1次。血压由动态血压监测仪记录。结果平均动脉压的最大下降值分别为培哚普利组(1.37±1.09)mmHg(1mmHg=0.133kPa)，依那普利组（4.65±1.58）mmHg，两组相比差异有极显著性（P＜0.0001）。整个观察期间，舒张压下降＞10mmHg者分别为依那普利组10例（7.3%），培哚普利组6例（4.2%），两组间比较，差异无显著性。未见症状性低血压反应。结论培哚普利在首次用于充血性心力衰竭的治疗时安全、不易产生低血压反应。

Differences in first dose response to perindopril or enalapril in congestive heart failure: a randomized controlled study

Objective　To test the hypothesis that not all angiotensin converting enzyme inhibitors produce first dose hypotension when they are initiated. Methods　A multi-center, randomized, open, drugs controlled parallel study was conducted. Two hundred and eighty-one selected patients with chronic congestive heart failure (NYHA class II-IV ) were randomized to receive a first dose of perindopril 2 mg (n=144) or enalapril 2.5 mg (n=137). Blood pressure was measured at baseline, every half an hour during the first 10-hour period after drug treatment and recorded by ambulatory blood pressure monitor. Results　The two groups of patients were similar in age, severity of heart failure, left ventricular ejection fraction value and mean arterial pressure. After administration of drugs, enalapril caused falls of mean arterial pressure at 1-4h, 5.5h and 8-10h period (P<0.05). Perindopril caused a small fall of mean arterial pressure over observation period. The maximum drops of mean arterial pressure were (1.37±1.09) mm Hg and (4.65±1.58) mm Hg in perindopril group and enalapril group respectively (P<0.000 1). Diastolic blood pressure of 10 ( 7.3% ) patients in enalapril group and 6 (4.2%) patients in perindopril group fallen more than 10 mm Hg (P>0.05). There were no significant changes in mean systolic and diastolic blood pressure before and after treatment in both groups. Conclusion　Perindopril seems to be safe and not likely to result in first dose hypotension following its initiation.