心力衰竭患者应用培哚普利与卡托普利的首剂低血压反应比较

First-dose hypotension response to perindopril and captopril in patients with chronic heart failure

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 response of first-dose hypotension to 2 mg perindopril and 6.25 mg captopril in patients with chronic heart failure (CHF). Methods A multicentre, randomized, parallel-controlled study was carried out. 167 patients (59-91 years old) with CHF were randomized to receive 2 mg of perindopril (n=89) or 6.25 mg of captopril (n=78). Blood pressure was monitored by ambulatory blood pressure measurement 2 hours before and 8 hours following drug intake. Results The incidence of first-dose hypotension (defined as fall in mean arterial pressure≥20 mm Hg and systolic blood pressure <90 mm Hg) was 10.1% in the perindopril group, significantly lower than that in the captopril group (20.5%, P<0.05). All first-dose hypotensive responses were asymptomatic. Captopril elicited greater mean maximum reduction in SBP compared with perindopril [maximum drop in SBP,(24.9± 17.6)mm Hg vs(19.2±15.7)mm Hg, P=0.026]. One third of the patients in first-dose hypotension group had the history of prior myocardial infarction. The incidence of first-dose hypotension was higher in the patients with prior myocardial infarction than in the patients without the history of myocardial infarction (34.8% vs 12.2%, P<0.01). Conclusions Perindopril caused less first-dose hypotension than captopril in patents with CHF. Perindopril was a safer agent for the treatment of CHF. Patients with CHF associated with prior myocardial infarction are susceptible population for first-dose hypotension.