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Impact of angiotensin converting enzyme inhibition on the haemodynamic profile during laboratory stress tests
R E Schmieder1, H Rüddel, H Schächinger
1Department of Medicine, University of Bonn, Germany.
Insights
Angiotensin converting enzyme (ACE) inhibitors like lisinopril reduce blood pressure during stress in hypertensive patients. ACE inhibition attenuates vasoconstriction, potentially protecting the cardiovascular system from stress-induced effects.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Essential hypertension is characterized by elevated blood pressure.
- Understanding the cardiovascular response to stress in hypertensive patients is crucial.
- Angiotensin converting enzyme (ACE) inhibitors are a common treatment for hypertension.
Purpose of the Study:
- To investigate the hemodynamic profile of ACE inhibitors during various stress conditions.
- To assess the cardiovascular response to stress before and after lisinopril therapy in hypertensive patients.
Main Methods:
- A trial involving 18 white patients with essential hypertension, 12 of whom completed the protocol.
- Patients underwent various stress tests (mental stress, cold pressor test, reaction time task, physical exercise) before and after three months of lisinopril therapy.
- Hemodynamic parameters including blood pressure, cardiac output, and total peripheral resistance were measured.
Main Results:
- Lisinopril significantly reduced systolic and diastolic blood pressure at rest and during mental stress, cold pressor test, and reaction time task.
- Diastolic pressure was significantly reduced during physical exercise.
- Total peripheral resistance was reduced at rest and its increase during the cold pressor test was attenuated by ACE inhibition.
Conclusions:
- ACE inhibitors, specifically lisinopril, effectively reduce blood pressure during diverse stressful events in middle-aged men with essential hypertension.
- Lisinopril does not alter the overall hemodynamic profile during stress but attenuates vasoconstriction.
- This response pattern may mitigate the impact of stress-induced blood pressure surges and exaggerated vasoconstriction on the cardiovascular system.
Abstract:
To determine the haemodynamic profile of angiotensin converting enzyme (ACE) inhibitors during stress, the cardiovascular response to various stress tests was examined in patients with essential hypertension before and after three months of therapy with lisinopril. Eighteen white patients were enrolled in the trial, of whom 12 completed the protocol. ACE inhibition with lisinopril effectively reduced systolic and diastolic pressure in the office (P less than 0.001), at rest (P less than 0.002), during mental stress (P less than 0.003), cold pressor test (P less than 0.003), and reaction time task (P less than 0.05). During physical exercise only diastolic pressure was significantly reduced (P less than 0.02). The fall in peak systolic pressure during cold pressor test and reaction time task was more pronounced than the fall in casual systolic pressure (P less than 0.05). At rest, cardiac output was unchanged, but total peripheral resistance was reduced after medication with lisinopril (P less than 0.05). During the cold pressor test, the increase in total peripheral resistance was attenuated by ACE inhibition (P less than 0.04). The haemodynamic response profile was not altered during the other tests. It is concluded that in middle-aged men ACE inhibitors reduce blood pressure during a variety of stressful events without altering the haemodynamic profile and even attenuating vasoconstriction during stress. This response pattern to ACE inhibition with lisinopril may reduce the impact of recurring stress-induced increases of blood pressure and of exaggerated vasoconstrictive stimuli on the cardiovascular system.