The effect of antihypertensive drugs on vascular compliance

Abstract

Measurement of vascular compliance has assumed increasing importance as a marker of early disease of the vascular wall, a predictor of future vascular disease, and a way to monitor the effects of vasoactive agents on arterial wall stiffness. Vascular compliance can be estimated by several methods: measurement of the pulse pressure, or pulse pressure-stroke volume ratio; analysis of the systolic pulse wave augmentation index and the diastolic pulse wave contour; ultrasonic echo-tracking; and MRI. Because few comparative studies have been done, the physiologic significance of the measures of compliance obtained by each method is uncertain. Antihypertensive drugs may improve vascular compliance by reducing blood pressure, relaxing vascular smooth muscle, or promoting long-term effects on vascular smooth muscle and cardiomyocyte growth and remodeling. Angiotensin converting enzyme (ACE) inhibitors have been reported to improve vascular compliance in nearly all studies, suggesting a beneficial class effect independent of blood pressure reduction. Favorable changes in the vascular wall-lumen ratio of small vessels from subcutaneous gluteal biopsy specimens after treatment with ACE inhibitors and the persistence of improved vascular compliance after withdrawal of therapy indicate that these agents may produce long-term vascular remodeling. Although few studies have been done, angiotensin II receptor antagonists improve vascular compliance, possibly by blocking angiotensin II-mediated cell proliferation and increasing apoptosis via unopposed AT1 receptor stimulation. In contrast, calcium antagonists and beta-blockers have variable effects on vascular compliance, although beta-blockers with intrinsic sympathomimetic activity improve vascular compliance. Diuretics have little effect on vascular compliance beyond their blood pressure-lowering actions, except for spironolactone, which by improving vascular compliance may have contributed to the reduction in heart failure mortality seen in the Randomized Aldactone Evaluation Study.

Vascular Compliance in Lean, Obese, and Diabetic Children and Adolescents: A Cross-Sectional Study in a Minority Population

“…The increase in vascular compliance in our diabetic subjects receiving antihypertensive drug therapy compared with those not receiving antihypertensive therapy is consistent with the improvement observed in studies of ACE inhibitors, angiotensin receptor blockers, and other antihypertensive agents [30,31] . ACE inhibitors have been shown to increase vascular compliance by blocking the effect of angiotensin II in promoting vascular smooth muscle and cardiomyocyte growth and remodeling.…”

Trait Anger and Arterial Stiffness: Results From the Atherosclerosis Risk in Communities (ARIC) Study

“…Those effects include the relaxation of smooth muscles in the vascular walls, inhibition of the accumulation of collagen fibers, decrease in vasomotor tone, and vascular remodeling. 22 Approximately one third of all participants in this analysis were hypertensive, and the prevalence of antihypertensive medication use among them was 74%. Moreover, men and women in the highest anger category, compared with their counterparts, were more likely to use antihypertensives.…”

Pulse Pressure Responses in Patients Treated with Valsartan and Hydrochlorothiazide Combination Therapy

“…16 The renin-angiotensin system is involved in the development of arterial stiffness, 17 and ARBs have been shown to improve arterial structure in hypertensive patients. 17,18 The combination Val/HCTZ might be expected therefore to improve arterial elasticity, bringing long-term benefits as well as the immediate effects of reducing PP. Val added to an ACE inhibitor has been shown to have additional benefits on arterial stiffness and PP amplification in patients poorly controlled on their usual treatment.…”