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Anti-ischemic effects of angiotensin- converting enzyme inhibition in hypertension

A Prasad1, R Mincemoyer, A A Quyyumi

  • 1Cardiology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1650, USA.

Journal of the American College of Cardiology
|October 5, 2001
PubMed

Insights

Angiotensin-converting enzyme (ACE) inhibition improved exercise-induced myocardial ischemia in hypertensive patients with coronary artery disease. This suggests ACE inhibitors can help manage ischemia by increasing bradykinin (BK) bioavailability.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Bradykinin (BK) responses are diminished in hypertension.
  • Endothelial dysfunction in hypertension exacerbates myocardial ischemia via abnormal coronary vasomotion.
  • ACE inhibition may augment BK bioavailability.

Purpose of the Study:

  • To determine if augmenting bradykinin (BK) bioavailability with angiotensin-converting enzyme (ACE) inhibition reduces exercise-induced myocardial ischemia in hypertensive patients with coronary artery disease (CAD).

Main Methods:

  • 14 hypertensive (HT) and 17 normotensive (NT) patients with CAD underwent treadmill tests and forearm vasodilator response to BK assessment.
  • Patients received oral enalapril (EN) titrated from 2.5 to 20 mg daily for seven days.
  • Measurements were taken before and after enalapril treatment.

Main Results:

  • Enalapril improved the ischemic threshold, exercise duration, and maximum exercise duration in hypertensive patients, but not normotensive patients.
  • Forearm blood flow responses to BK improved with enalapril in all patients.
  • No correlation was found between the dose of enalapril and the improvement in exercise ischemic threshold.

Conclusions:

  • ACE inhibition ameliorates exercise-induced myocardial ischemia in hypertensive patients with CAD.
  • The mechanism may involve enhanced bradykinin bioavailability.
Abstract

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