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Increased vascular compliance/decreased cardiovascular risk: what the studies tell us
1Department of Medicine, Munger Pavilion, Room 263, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA. william_frishman@nymc.edu
Insights
Improving arterial compliance is key to managing hypertension and reducing cardiovascular risks. Clinical trials show that treatments enhancing arterial compliance significantly lower stroke, heart attack, and mortality rates.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Pharmacology
Background:
- Arterial stiffness and reduced arterial compliance are early indicators of hypertension.
- Isolated systolic blood pressure elevations correlate with decreased arterial compliance.
- Clinical trials suggest improved arterial compliance reduces cardiovascular disease risk.
Purpose of the Study:
- To evaluate the impact of interventions on arterial compliance in hypertension.
- To assess the cardiovascular benefits of improving arterial compliance.
- To explore the role of ACE inhibitors in enhancing arterial compliance.
Main Methods:
- Analysis of clinical trials focusing on isolated systolic hypertension treatments.
- Review of data from the Systolic Hypertension in the Elderly Program, Systolic Hypertension in Europe, and Systolic Hypertension in China.
- Examination of the Heart Outcomes Prevention Evaluation study on ACE inhibitor effects.
Main Results:
- Antihypertensive therapy in older adults with isolated systolic hypertension lowered systolic blood pressure and pulse pressure.
- Treatment led to significant reductions in stroke, myocardial infarction, coronary death, and all-cause mortality.
- Angiotensin-converting enzyme (ACE) inhibitors provided risk reduction with minimal blood pressure lowering, suggesting benefits beyond blood pressure control.
Conclusions:
- Improving arterial compliance is a crucial therapeutic target in hypertension management.
- Treatments that enhance arterial compliance offer significant cardiovascular protection.
- ACE inhibitors improve endothelial function, thereby enhancing arterial compliance and reducing cardiovascular events.
Abstract:
Increasing arterial stiffness and decreasing arterial compliance are now thought to occur at the beginning of the hypertension disease process. Decreased arterial compliance is associated with isolated systolic blood pressure elevations. Many clinical trials of isolated systolic hypertension provide indirect evidence that improving compliance lowers the risk of cardiovascular disease. The Systolic Hypertension in the Elderly Program showed that antihypertensive therapy in older patients with isolated systolic hypertension lowers systolic blood pressure and narrows pulse pressure without unduly lowering diastolic blood pressure. Treatment over 5 years significantly reduced the incidence of stroke, nonfatal myocardial infarction and coronary death, all cardiovascular events, and all-cause mortality. The Systolic Hypertension in Europe and Systolic Hypertension in China trials showed similar effects on pulse pressure and on clinical end points. The Heart Outcomes Prevention Evaluation was a primary prevention study of the effect of an angiotensin-converting enzyme (ACE) inhibitor in subjects who were not necessarily hypertensive but were at risk for cardiovascular events. With minimal lowering of blood pressure, ramipril therapy provided significant risk reduction in all major end points--overall mortality, stroke, myocardial infarction, and cardiovascular death. ACE inhibitors restore endothelial cell balance to improve arterial compliance, thus they can provide benefits beyond lowering blood pressure.