摘要
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及靶剂量达标率。方法采用单中心、随机、平行对照的研究,227例(60￣78岁)的心衰患者(左室射血分数≤45%)随机接受2mg的培哚普利(119例)或6.25mg的卡托普利(108例)治疗。应用多参数监护仪监测用药前1h及用药后15d内的血压改变。结果以平均动脉压下降≥20mmHg(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(8.4%与16.7%,P<0.05)。培哚普利组最大的收缩压下降明显小于卡托普利组[(10.4±5.2)mmHg与(16.3±6.8)mmHg,P<0.05];以用药15d后培哚普利4mg,1/d,卡托普利≥25mg,3/d为靶剂量计算达标率,培哚普利组的达标率明显高于卡托普利组(82.9%与53.7%,P<0.01)。首剂低血压的发生与心肌梗死病史有关,合并陈旧性心梗的心衰患者首剂低血压高于未合并陈旧性心梗的心衰患者组(23.7%与9.5%,P<0.01)。靶剂量未达标原因中,主要与收缩压<90mmHg有关。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,其靶剂量达标率高,是一个相对安全的药物。合并陈旧性心梗的心衰患者易发生首剂低血压;收缩压<90mmHg是靶剂量未达标的主要原因。
[Objective] To observe the responds of first-dose hypotension and the control rate of butt-dose cure to perindopril 2mg and captopril 6.25 mg in patients with chronic heart failure（CHF）. [Methods] A single-centre, randomized, parallel- controlled trial was perforated.227 patients （60-78 years old） with CHF were randomly administered 2 mg of perindopril （n =119） or 6.25 mg of eaptoprii （n =108）. Blood pressure was monitored by muiti-paramenters blood pressure measurement 1 hour before and 15 days after taking the medicine. [Results] The incidence of first-dose hypotension （defined as reduction of average arterial blood pressure 〉20 mmHg and systolic blood pressure〈90 mmHg） in the perindopril group was significantly lower than that in the eaptopril group （8.4% vs 6.7%, P 〈 0.05）. Captopril elicited greater reduction to maximum SBP compared with perindnpril [（16.3±6.8） mmHg vs （10.4± 5.2） mmHg, P 〈0.05]. Based on taking perindopril 4mg once daily and 25mg every day three, the control rate of butt-dose cure in perindopril group was higher than in eaptopril group （82.9% vs 53.7%, P 〈0.01）. The oceurreuee of first-dose hypotension was higher in the patients with forme, myocardial infarction than in those without the history of myocardial infarction （2.3.7% vs 9.5% P 〈0.01）. The reason of the butt-dose not curing aright he principally associated with the systolic blood pressure〈90 mmHg. [Conclusions] Perindopril caused less first-dose hypotension than eaptopril in patients with CHF. Perindopril was a relatively safe medieine fur the treatment of CHF, which had higher eontrol rate of butt-dose, CHF patients with former myocardial infarction were susceptible to first-dose hypotension. Systolic blood pressure〈90 mmHg was the major reason of the butt-dose not curing .
出处
《中国医学工程》
2006年第1期31-34,共4页
China Medical Engineering
关键词
心力衰竭
充血性
培哚普利
低血压
heart failure
congestive
perindopril
hypotension
