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[Cardiac hypertrophy and arterial compliance after antihypertensive treatment]
R G Asmar1, B M Pannier, G M London
1Service de médicine interne et de l'INSERM, hôpital Broussais, Paris.
Insights
Perindopril treatment significantly reduced blood pressure and improved arterial compliance in patients with essential hypertension. This ACE inhibitor directly impacts arteries, enhancing blood flow and diameter, unlike flow-dependent dilation alone.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hypertension Research
Background:
- Hypertension-induced cardiac hypertrophy is linked to increased vascular resistance and reduced aortic compliance.
- Decreased aortic compliance in hypertension may elevate systolic blood pressure and end-systolic wall stress, promoting cardiac hypertrophy.
Purpose of the Study:
- To investigate the effects of perindopril, an ACE inhibitor, on blood pressure and arterial hemodynamics in patients with essential hypertension.
- To determine if perindopril's effects on arterial diameter are solely flow-dependent or involve direct drug action.
Main Methods:
- A blinded, placebo-controlled study involving 16 patients with permanent essential hypertension.
- Measurements included blood pressure, forearm arterial hemodynamics (pulsed Doppler), and echocardiographic parameters before and after 3 months of perindopril treatment.
- Assessed changes in brachial arterial compliance and pulse wave velocity.
Main Results:
- Perindopril significantly reduced blood pressure (p < 0.01) and increased brachial blood flow (p < 0.01) due to enhanced velocity and arterial diameter.
- Perindopril's effect on arterial diameter was not solely flow-dependent, suggesting a direct vascular action.
- Brachial arterial compliance increased (p < 0.01) and pulse wave velocity decreased (p < 0.01) with perindopril treatment.
Conclusions:
- Perindopril effectively lowers blood pressure and improves arterial compliance in essential hypertension.
- The drug exerts a direct beneficial effect on arterial properties beyond simple vasodilation.
- These findings support perindopril's role in managing hypertension and associated vascular remodeling.
Abstract:
Cardiac hypertrophy in hypertension is related to increased peripheral vascular resistance and reduced aortic compliance. Non-invasive measurement of pulse wave velocities and systolo-diastolic variations of the diameter of the aortic arch show that an increase in the elastic modulus of the aorta is closely related to the increase in cardiac mass. This relationship holds even after correction for mean arterial pressure. Therefore, it has been suggested that, in hypertension, the decreased aortic compliance leads to a disproportionate increase in systolic blood pressure and end systolic wall stress, predisposing to cardiac hypertrophy. The blood pressure, arterial haemodynamics of the forearm (by pulsed Doppler flow measurement) and echocardiographic parameters were studied in 16 patients with permanent essential hypertension, before and 3 months after treatment with perindopril, an ACE inhibitor. In a simple blinded study versus placebo, perindopril was shown to significantly reduce the blood pressure (p less than 0.01) while brachial blood flow increased (p less than 0.01) because of a simultaneous increase in blood flow velocity and arterial diameter. During 5 minutes' occlusion at the wrist, blood flow velocity decreased more in patients taking perindopril than those on placebo (p less than 0.01) whilst the reduction in arterial diameter was equivalent, indicating that the increase in arterial diameter with perindopril could not be explained by flow-dependent dilatation alone but by a direct effect of the drug on the artery. During the treatment phase, brachial arterial compliance increased (p less than 0.01) and pulse wave velocity decreased (p less than 0.01) and there was no change in arterial shear stress defined as the product of mean blood pressure and arterial diameter.(ABSTRACT TRUNCATED AT 250 WORDS)