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The effect of antihypertensive drugs on vascular compliance
N Winer1, M A Weber, J R Sowers
1Division of Endocrinology, Diabetes, and Hypertension, SUNY Downstate Medical Center, Box 1205, 450 Clarkson Avenue, Brooklyn, NY 11203-2098, USA. nwiner@netmail.hscbklyn.edu
Insights
Vascular compliance measurement is crucial for detecting early vascular disease. Angiotensin converting enzyme (ACE) inhibitors consistently improve vascular compliance, suggesting long-term remodeling benefits beyond blood pressure reduction.
Area of Science:
- Cardiovascular Physiology
- Pharmacology
- Medical Diagnostics
Background:
- Vascular compliance is a key indicator of vascular health and a predictor of future cardiovascular events.
- Assessing arterial wall stiffness is vital for monitoring disease progression and treatment efficacy.
- Several methods exist to estimate vascular compliance, but their physiological significance requires further clarification.
Purpose of the Study:
- To review the role of vascular compliance measurement in cardiovascular disease.
- To examine the impact of various antihypertensive drug classes on vascular compliance.
- To explore the mechanisms by which certain drugs may induce long-term vascular remodeling.
Main Methods:
- Review of existing literature on vascular compliance measurement techniques.
- Analysis of studies investigating the effects of antihypertensive medications on vascular compliance.
- Examination of evidence for drug-induced vascular remodeling.
Main Results:
- Angiotensin converting enzyme (ACE) inhibitors demonstrate a consistent, class-independent improvement in vascular compliance.
- ACE inhibitors may promote long-term vascular remodeling, as evidenced by changes in vessel wall-lumen ratio and persistent compliance improvements.
- Angiotensin II receptor antagonists show potential benefits, while calcium antagonists and beta-blockers have variable effects. Spironolactone uniquely improves vascular compliance among diuretics.
Conclusions:
- Vascular compliance is an important marker for early vascular disease and treatment monitoring.
- ACE inhibitors offer significant benefits for vascular compliance, likely through mechanisms beyond blood pressure reduction, including vascular remodeling.
- Further research is needed to fully elucidate the effects of different drug classes on vascular compliance and long-term vascular health.
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.