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探讨血管紧张素转换酶抑制剂卡托普利对急性心肌梗死病人早期血压、心率、死亡率及临床事件的影响。方法多中心随机双盲安慰剂对照临床试验，给发病３６ｈ内的急性心肌梗死病人随机口服卡托普利（ｎ＝７４６８，１２．５ｍｇ３／ｄ）或安慰剂（ｎ＝７４９４）治疗４周。结果基础血压＜１００ｍｍＨｇ或舒张压＜７０ｍｍＨｇ、心率＜７０ｍｉｎ－１者，卡托普利组４周总死亡率略高于安慰剂对照组；基础收缩压≥１００ｍｍＨｇ或舒张压≥７０ｍｍＨｇ、心率≥７０ｍｉｎ－１（尤其心率偏快）者，卡托普利组死亡率均低于对照组。用首剂（６．２５ｍｇ）药后２ｈ收缩压或舒张压较前下降１０％～１９％者卡托普利组死亡率（８．５％，７．１％）均明显低于对照组（１０．７％，Ｐ＝０．０４；１０．０％，Ｐ＝０．００３），而血压下降幅度＜１０％者两组死亡率相似。基础收缩压＜１００ｍｍＨｇ者卡托普利组休克发生率（１０．０％）高于对照组（７．８％），低血压发生率（３６．５％ｖｓ２４．０％）更高。基础心率＜６０ｍｉｎ－１者卡托普利组心力衰竭（１３．４％）、休克（５．８％）、室颤（２．８％）发生率均略高于对照组（１１．９％，３．６％，１．３％）；心率≥６０ｍｉｎ－１者卡托普利
To investigate the effect of captopril, an angiotensin converting enzyme inhibitor, on early blood pressure, heart rate, mortality and clinical events in patients with acute myocardial infarction. Methods A multicenter, randomized, double-blind, placebo-controlled clinical trial randomized patients with acute myocardial infarction within 36 hours of treatment to receive either captopril (n = 7468, 12.5 mg 3 / d) or placebo (n = 7494) for 4 weeks. Results The total 4-week mortality of captopril group was slightly higher than that of placebo control group with basal blood pressure <100mmHg or diastolic blood pressure <70mmHg and heart rate <70min-1; basal systolic blood pressure≥100mmHg or diastolic blood pressure≥70mmHg, heart rate≥70min -1 (especially fast heart rate), captopril group mortality were lower than the control group. With the first dose (6.25mg) 2h after systolic blood pressure or diastolic blood pressure decreased by 10% to 19% compared with the previous captopril group mortality (8.5%, 7.1%) were significantly lower than the control group 10.7%, P = 0.04; 10.0%, P = 0.003), while the reduction of blood pressure was less than 10%. The basal systolic blood pressure <100 mmHg in captopril group was higher than that in control group (7.8%), and the incidence of hypotension (36.5% vs 24.0%) was higher. The incidence of heart failure (13.4%), shock (5.8%) and ventricular fibrillation (2.8%) in captopril group was significantly higher than that in control group (11.9% , 3.6%, 1.3%); captopril heart rate ≥ 60min-1