Related Experiment Videos
Changes in arterial structure and function under trandolapril-verapamil combination in hypertension
J Topouchian1, R Asmar, F Sayegh
1Department of Internal Medicine, Broussais Hospital, Paris, France.
Insights
Hypertension treatments including ACE inhibitors and calcium channel blockers affect large arteries. Site-specific arterial changes were observed, with combination therapy showing greater blood pressure reduction and improved arterial distensibility.
Area of Science:
- Cardiovascular medicine
- Pharmacology
- Hypertension research
Background:
- Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers impact large arteries in hypertension.
- Previous research has not investigated the site-specific heterogeneity of these arterial responses.
Purpose of the Study:
- To investigate the impact of verapamil, trandolapril, and their combination on large arteries at different measurement sites.
- To analyze the heterogeneity of cardiovascular responses based on arterial site.
Main Methods:
- A 180-day double-blind study comparing verapamil, trandolapril, and combination therapy in hypertensive patients.
- Utilized echo-Doppler and applanation tonometry to measure pressure, diameter, and distensibility at brachial, carotid, and aortic sites.
- Assessed cardiac and carotid wall structure changes.
Main Results:
- Combination therapy yielded greater reductions in mean and pulse pressures.
- Significant increases in arterial distensibility were observed across multiple sites (carotid, aorta, brachial).
- Reduced abdominal aorta and carotid artery diameter; cardiac mass regression was more pronounced than carotid wall thickening.
Conclusions:
- Both ACE inhibitors and calcium channel blockers, especially in combination, effectively lower blood pressure.
- Arterial diameter, thickness, and stiffness modifications are site-dependent.
- Muscular arteries showed increased distensibility, while cardiac hypertrophy regressed significantly.
Background And Purpose:
Converting enzyme inhibition and calcium blockade alter large arteries in hypertension. However, the heterogeneity of the response according to the site of cardiovascular measurements has never been investigated.
Methods:
In a double-blind study, we compared for 180 days 3 hypertensive patient groups treated with verapamil, trandolapril, or their combination. Using echo-Doppler technique and applanation tonometry, we independently measured mean pressure, local pulse pressure, arterial diameter, and distensibility at 3 arterial sites (brachial and common carotid arteries and abdominal aorta), as well as cardiac and carotid wall structure.
Results:
Mean and pulse pressure decreased significantly to a greater extent with the drug combination. Regarding arterial and cardiac hemodynamics, significant and similar changes were noted in the 3 groups: decreases in abdominal aorta and carotid but not brachial diameter; increases in carotid artery, abdominal aorta, and brachial distensibility even after adjustment to mean blood pressure reduction; and more substantial regression of cardiac mass than carotid wall thickness.
Conclusions:
This study shows that both compounds and more significantly combination therapy decreased mean and pulse pressures measured independently and that the changes in diameter, thickness, and stiffness were influenced primarily by the site of cardiovascular measurements, resulting in a predominant increase in distensibility of muscular arteries, little change in carotid wall thickness, but a significant regression of cardiac hypertrophy.