Converting Enzyme Inhibitor Improves Forearm Reactive Hyperemia in Essential Hypertension

Abstract

Endothehal function 1s known to be ImpaIred m essential hypertensive patients In this study, we examined whether antihypertensive drugs improve forearm vasochlatory response to reactive hyperenna m 26 patients with essential hypertension (6222 years) without dtabetes melhtus, hyperhpldemla, coronary heart disease, or cerebrovascular disease AntIhypertensive drugs were never given or were chscontmued for at least 4 weeks before the study Patients were treated with monotherapy of &her temocaprtl (2 or 4 mg, n= 15) or amlochpme (2 5 or 5 mg, n= 11) for 6 months Forearm blood flow was measured by strain-gauge plethysmography Vasodilator response to the release of upper arm compression at 300 mm Hg for 5 minutes and to sublingual admmistration of mtroglycenn (0 3 mg) were assessed Changes of forearm blood flow response to reactive hyperenna were sigmficantly less m hypertensive patients (99218%) than m age- E ndothehal cells play a pIvota role m the modulation of vascular tone by releasing vasoactive substances, such as endothelm, prostaglandm, and endothelium-derived relaxing factor (EDRF). 1~2 In the early stage of atherogenesis, endothehal cell function 1s known to be disturbed.3 This results in lmpairment of the vasochlator response to acetylcholme, which requires Intact endothehal function 4 There 1s considerable evidence that the endothehum-dependent vasodilation 1s impaired in human essential hypertenslon.5.10 The effects of various antlhypertenslve drugs on hypertension-induced endothehal dysfunction have been examined widely. In animal studies, angiotensmconverting enzyme (ACE) mhWors have been shown to improve endothehal function. II-14 However, m human hypertension, the results are not consistent, several investigators demonstrated that ACE mhibltors improved endothelial dysfunction m hypertensive patients,l5-17 while others failed to show an lmprovement 18,19 The effect of calcium antagonists has not been fully examined except m rats13 and an acute human study '6 CelermaJer et al*0 evaluated endothehal function by Doppler system m the brachlal and femoral arteries during reactive hyperemla and after sublmgual adnumstration of nitroglycerm. Both procedures induce vasochlation; however, the former 1s partly mediated by Hlgashlosaka 577 Japan E-mail nagano@ gerlat med Osaka-u ac JP 0 1997 American Heart Assoclatlon, Inc EDRF,2',22 while the latter acts directly on smooth muscle cells. In this study, we used CelermaJor's method with modlficatlon to evaluate the effects of an ACE mhlbitor, temocapnl, and a calcium antagonist, amlochpine, on forearm vasodllator response m patients with essential hypertension These drugs were given as monotherapy for 6 months in hypertensive patients without any overt chnlcal evidence of atherosclerosis Subjects MethodsThe SubJects were 26 panents with essential hypertension aged 52 to 80 years (mean+-SEM, 62?2 years) and another 37 age-and sexmatched normotensive mdividuals as control Hypertension was defined as systolic blood pressure at the outpatient department of ...

Effects of Angiotensin Converting Enzyme Inhibitor and Calcium Antagonist on Endothelial Function in patients with Essential Hypertension.

“…But several other studies have demonstrated that treatment with a calcium antagonist did not improve forearm vasodilator response to reactive hyperemia or to acetylcholine (9,10,22). In our findings, prolonged (8 weeks of oral treatment) amlodipine administration did improve endothelium-dependent vasodilation in essential hypertensive patients.…”

“…Because we did not assess FBF responses to sodium nitroprusside infusion after antihypertensive treatment, it may appear that this finding is inconclusive. However, Taddei et al found that the response to sodium nitroprusside was not changed after antihypertensive treatment (19), and other studies have also reported that endothelium-independent vasodilation did not change after treatment (9,10,12,22). We therefore consider that our findings on endothelium-dependent vasodilation could be conclusive.…”

“…Several studies have demonstrated that restoration of endothelial function through the administration of antihypertensive agents is essential in the treatment of hypertensive patients (8)(9)(10), while others have shown that effective antihypertensive therapy did not restore impaired endotheliumdependent vasodilation in the forearm circulation of hypertensive patients (11,12).…”

Inhibition of Neointima by Angiotensin-Converting Enzyme Inhibitor in Porcine Coronary Artery Balloon-Injury Model

“…26 The contribution of increase in local HGF expression by ACE inhibition to endothelial function may also be more general, given that treatment with ACE inhibitors is well known to improve endothelial dysfunction in human hypertensive patients. 27,28 However, the present study has limitations. Recent studies demonstrated the lack of chymase, an alternative Ang II-generating enzyme, in a porcine model.…”

Effect of nifedipine on endothelial function in normotensive smokers: potential contribution of increase in circulating hepatocyte growth factor

“…The procedure has been previously published in detail. 17 Reactive hyperaemia ratio was calculated as hyperaemia/baseline value of FBF, reflecting endothelium-dependent vasodilatation. The nitroglycerin-induced hyperaemia/baseline value of FBF was calculated as endothelium-independent vasodilatation.…”