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Different effect of antihypertensive drugs on conduit artery endothelial function
Lorenzo Ghiadoni1, Armando Magagna, Daniele Versari
1Department of Internal Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy. l.ghiadoni@int.med.unipi.it
Insights
Angiotensin-converting enzyme (ACE) inhibitors, specifically perindopril, uniquely improved blood vessel dilation in hypertensive patients. Other antihypertensive drugs lowered blood pressure but did not enhance endothelial function.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is characterized by impaired endothelium-dependent vasodilation.
- Peripheral conduit artery endothelial function is a crucial marker for cardiovascular health.
- The impact of various antihypertensive drug classes on endothelial function requires detailed comparison.
Purpose of the Study:
- To compare the effects of six different antihypertensive drug classes on endothelium-dependent vasodilation in patients with essential hypertension.
- To assess changes in oxidative stress and antioxidant capacity alongside endothelial function.
- To identify which drug class, if any, improves conduit artery endothelial function.
Main Methods:
- Prospective, randomized, parallel group study involving 168 hypertensive patients and 40 healthy controls.
- Assessment of brachial artery flow-mediated dilation (endothelium-dependent) and glyceryl trinitrate response (endothelium-independent) using high-resolution ultrasound.
- Measurement of plasma malondialdehyde, lipoperoxides, and ferric-reducing antioxidant power to evaluate oxidative stress and antioxidant capacity.
Main Results:
- Hypertensive patients exhibited significantly lower flow-mediated dilation compared to healthy controls.
- All tested antihypertensive treatments effectively reduced blood pressure.
- Only perindopril (an ACE inhibitor) significantly improved flow-mediated dilation without affecting endothelium-independent vasodilation. Perindopril, telmisartan, nifedipine, and amlodipine reduced oxidative stress.
Conclusions:
- In patients with essential hypertension, angiotensin-converting enzyme (ACE) inhibitors are the only drug class demonstrated to improve conduit artery endothelium-dependent vasodilation.
- While other antihypertensives manage blood pressure, ACE inhibitors offer an additional benefit for vascular endothelial health.
- The findings highlight the importance of selecting antihypertensives that not only control blood pressure but also positively impact endothelial function.
Abstract:
To compare the effect of antihypertensive drugs on endothelium-dependent vasodilation in the peripheral conduit arteries of patients with essential hypertension, in a prospective, randomized, parallel group study, endothelial function was assessed in 168 hypertensive patients before and after 6-month treatment with randomly assigned nifedipine GITS (30 to 60 mg, n=28), amlodipine (5 to 10 mg, n=28), atenolol (50 to 100 mg, n=29), nebivolol (5 to 10 mg, n=28), telmisartan (80 to 160 mg, n=29), and perindopril (2 to 4 mg, n=28). If necessary, hydrochlorothiazide (25 mg) was added to each compound. We evaluated brachial artery flow-mediated, endothelium-dependent dilation (high-resolution ultrasound) compared with endothelium-independent response to glyceryl trinitrate (25 microg/s). Brachial artery diameter was measured by automatic computerized analysis. Forty healthy subjects were evaluated as a control group. Oxidative stress production was evaluated by measuring plasma malondialdehyde and plasma lipoperoxides; plasma antioxidant capacity was assessed as ferric-reducing antioxidant power. Hypertensive patients showed a significantly (P<0.01) lower flow-mediated dilation (5.2+/-1.9%) as compared with healthy control subjects (7.1+/-2.6%). Response to glyceryl trinitrate was similar in control subjects and patients. At baseline, blood pressure, diameter, flow-mediated dilation, and response to glyceryl trinitrate were similar in the different treatment groups. All treatments similarly reduced blood pressure, but only perindopril increased flow mediated dilation (from 5.1+/-2 to 6.4+/-2.4%; P<0.01) without modifying the response to glyceryl trinitrate. Perindopril but also telmisartan nifedipine and amlodipine reduced oxidative stress and increased plasma antioxidant capacity. In patients with essential hypertension, ACE inhibitors appear to be the only compounds able to improve conduit artery endothelium-dependent vasodilation.