伊贝沙坦与卡托普利治疗老年慢性心力衰竭疗效与安全性比较

The comparison of irbesartan and captopril for the treatment of elderly patients with congestive heart failure

目的比较伊贝沙坦与卡托普利治疗老年慢性心力衰竭(CHF)的临床疗效及安全性。方法57例老年CHF患者在常规治疗基础上随机分为两组,即:伊贝沙坦(150mg/d,28例)组与卡托普利(75mg/d,29例)组,疗程为6个月。结果疗程结束后,伊贝沙坦组临床显效率46.43%,有效率50%,无效率3.57%;卡托普利组分别为48.28%、48.28%、3.44%。与治疗前比较,两组在左心室质量指数、左心室射血分数、左心室舒张末期内径、左心室收缩末期内径等相关参数均有显著改善;血压有所下降,血钾略有升高,但均在正常范围内,血肌酐无明显变化;两组各有1例因心力衰竭恶化而再次住院,无死亡病例;除刺激性干咳发生率伊贝沙坦组明显低于卡托普利组外,组间不良反应比较差异均无显著性意义。结论伊贝沙坦治疗老年CHF与卡托普利疗效相似,且耐受性、安全性更高,对老年CHF患者更为有益,可作为不能耐受ACEI老年CHF患者的优先选择。

Objective To compare the clinical efficacy and safety of irbesartan with that of captopril in the treatment for elderly patients with congestive heart failure (CHF).Methods On the basis of regular treatments, 57 elderly patients with CHF were randomly divided into two groups: irbesartan group (n=28) was treated with irbesartan150mg per day and captopril group (n=29) with captopril 75mg per day. The course of treatment was 6 months.Results After treatment, the cardiac function, LVMI, LVEF, LVEDd and LVESd were markedly improved in both groups, but not statistically different between the two groups. Although blood pressure decreased significantly, serum potassium increased slightly, both of them were in normal range. During the treatment, there was one patient rehospitalized because of deterioration of cardiac function and no death in both group. Irbesartan group is well tolerated and has lower incidence of cough compared to captopril group.Conclusion Irbesartan and captopril have similar efficacy on the treatment of the elderly CHF patients, but irbesartan is more tolerable and reliable than captopril. Irbesartan is more suitable for the elderly CHF patients and may be used as a first alternative in patients intolerant of ACEI.