Reversion of cardiac hypertrophy and reduced arterial compliance after converting enzyme inhibition in essential hypertension.

Abstract

Blood pressure, forearm arterial hemodynamics (with a pulsed Doppler flowmeter), and echocardiographic parameters were studied in 16 patients with sustained essential hypertension before and 3 months after administration of the converting enzyme inhibitor perindopril. In a single-blind study versus placebo, it was shown that perindopril significantly reduced blood pressure (p<O.Ol), whereas there was an increase in brachial blood flow (p<O.O1) because of a simultaneous increase in blood flow velocity (p<O.Ol) and arterial diameter (p<O.O1). During a 5-minute period of wrist occlusion, blood flow velocity was reduced to a greater extent with perindopril than with placebo (p<O.OOl), whereas corresponding reductions in arterial diameter were equivalent, indicating that the increase in diameter after perindopril could not be explained simply on the basis of flow-dependent dilatation. During active treatment, brachial artery compliance increased (p<0.01) and pulse wave velocity decreased (p<0.01), whereas there was no change in the tangential tension of the arterial wall, defined as the product of mean arterial pressure and arterial diameter. Four weeks after treatment was stopped, blood pressure and forearm arterial hemodynamics returned toward baseline values. Cardiac mass was significantly decreased after perindopril (p<0.01) and remained decreased 4 weeks after cessation of treatment. The study showed that the arterial modifications caused by perindopril, (i.e., an increase in arterial diameter and compliance) were largely unrelated to blood pressure reduction and involved a drug-related relaxation of arterial smooth muscle and that a differential response in cardiac and arterial changes occurred after the treatment was stopped. (Circulation 1988;78:941-950

Aggressive antihypertensive strategies based on hydrochlorothiazide, candesartan or lisinopril decrease left ventricular mass and improve arterial compliance in patients with type II diabetes mellitus and hypertension

“…It is therefore difficult to compare the results with those of previous studies, which studied non-diabetic patients, 14,[28][29][30][31] used monotherapy 14,[32][33][34] or were short-term. 16 The design of this study was meant to reflect clinical practice, in which hypertensive type II diabetic patients typically need more than one agent to achieve adequate blood pressure regulation according to current guidelines. 35 In this context, we show that aggressive antihypertensive treatment decreases LVM index and arterial stiffness, which may thus be pathways through which such treatment reduces cardiovascular risk.…”

“…[11][12][13] In addition, it has been suggested that left ventricular hypertrophy and arterial stiffness are more effectively reduced by renin-angiotensin system inhibitors than by diuretics 14,15 because ACE inhibitors and AT1 receptor antagonists may reverse structural changes of myocardium and large arteries 16 by inhibition of myocardial and vascular growth factors. However, the effects of aggressive antihypertensive strategies on left ventricular hypertrophy and arterial stiffness in type II diabetes (which itself is a risk factor for these conditions) have not been studied.…”

RAS inhibition in hypertension

“…Clinical evaluation of vascular damage is performed through study of changes in: (1) intimal medial thickness (IMT) of carotid arteries during carotid duplex ultrasound examination; (2) vascular endothelial function and (3) arterial compliance. At equal degrees of reduction in blood pressure, RAS inhibitors produced a greater reduction in carotid IMT, 36,37 greater improvement in vascular endothelial function assessed non-invasively by flow mediated dilatation in brachial artery 18,38 and in arterial compliance 18,39 when compared with other antihypertensive agents.…”

Angiotensin receptor blockade in the challenging era of systolic hypertension

“…[60][61][62] Accumulating evidence from recent clinical trials suggest beneficial effects of ACE inhibitors on arterial stiffness. [63][64][65][66][67] A small placebo-controlled trial showed that 3-months treatment with the ACE inhibitor perindopril increased brachial artery compliance and decreased pulse wave velocity. 63 These favourable effects on forearm arterial haemodynamics returned toward baseline values 4 weeks after treatment withdrawal.…”

“…[63][64][65][66][67] A small placebo-controlled trial showed that 3-months treatment with the ACE inhibitor perindopril increased brachial artery compliance and decreased pulse wave velocity. 63 These favourable effects on forearm arterial haemodynamics returned toward baseline values 4 weeks after treatment withdrawal. 63 A large multicentre uncontrolled study in 1703 hypertensive subjects showed that the antihypertensive effect of perindopril administered for 6 months was accompanied by a significant decrease in carotid-femoral pulse wave velocity.…”