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目的 观察心力衰竭 (心衰 )患者对小剂量血管紧张素转换酶抑制剂的首剂低血压反应。方法 采用多中心、随机、平行对照的研究 ,16 7例 (5 9～ 91岁 )的心衰患者 (左室射血分数≤4 0 % )随机接受 2mg的培哚普利 (89例 )或 6 2 5mg的卡托普利 (78例 )治疗。应用动态血压监测用药前 2h及用药后 8h的血压改变。结果 以平均动脉压下降≥ 2 0mmHg(1mmHg =0 133kPa)和收缩压 <90mmHg定义为首剂低血压反应 ,培哚普利组的发生率明显低于卡托普利组 (10 1%与2 0 5 % ,P <0 0 5 )。培哚普利组最大的收缩压下降明显小于卡托普利组 [(19 2± 15 7)mmHg与(2 4 9± 17 6 )mmHg ,P =0 0 2 6 ]。所有的首剂低血压反应均无症状 ,仅通过动态血压监测发现。首剂低血压的发生与既往心肌梗死病史有关 ,合并陈旧性心肌梗死的心衰患者首剂低血压的发生率高于无心肌梗死病史的心衰组 (34 8%与 12 2 % ,P <0 0 1)。结论 培哚普利 2mg应用于心衰患者的首剂低血压发生率较低 ,培哚普利是一个相对安全的药物。合并陈旧性心肌梗死的心衰患者是发生首剂低血压的易患人群。
Objective To observe the first hypotensive response of low-dose angiotensin-converting enzyme inhibitors in patients with heart failure (heart failure). METHODS: A multicenter, randomized, parallel-controlled study of 16 patients (59 to 91 years) with heart failure (left ventricular ejection fraction ≤ 40%) received either 2 mg of perindopril (n = 89) 6 2 5mg of captopril (78 cases) treatment. Application of ambulatory blood pressure monitoring 2h before medication and 8h after treatment of blood pressure changes. Results The first hypotensive hypotension was defined as a decrease in mean arterial pressure ≥ 20 mmHg (1 mmHg = 0,133 kPa) and systolic blood pressure <90 mmHg. The incidence of perindopril was significantly lower in the perindopril group than in the captopril group (10 1% vs 20 5%, P <0 0 5). The greatest reduction in systolic blood pressure was less in the perindopril group than in the captopril group [(19 2 ± 15 7) mmHg vs (299 ± 17 6) mmHg, P = 0.0026). All of the first dose hypotensive reactions were asymptomatic and were only detected by ambulatory blood pressure monitoring. The incidence of first-episode hypotension was associated with a history of previous myocardial infarction. The incidence of first-episode hypotension was higher in HF patients with AMI (34.8% vs 122%, P < 0 0 1). Conclusion Perindopril 2 mg has a lower incidence of first-dose hypotension in patients with heart failure, and perindopril is a relatively safe drug. Heart failure patients with old myocardial infarction is the first dose of hypotension prone people.