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Haemodynamic effects of perindopril in essential hypertension
R G Asmar1, B Pannier, S T Laurent
1Department of Internal Medicine, Hospital Broussais, Paris, France.
Insights
Perindopril, an ACE inhibitor, effectively lowers blood pressure and improves arterial function in hypertensive patients. Long-term treatment with perindopril also reduces cardiac mass, indicating sustained cardiovascular benefits.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Sustained essential hypertension is a major risk factor for cardiovascular disease.
- Angiotensin-converting enzyme (ACE) inhibitors are a cornerstone in hypertension management.
- Understanding the specific effects of ACE inhibitors on arterial hemodynamics and cardiac structure is crucial.
Purpose of the Study:
- To investigate the effects of the ACE inhibitor perindopril on blood pressure, forearm arterial hemodynamics, and echocardiographic parameters in patients with essential hypertension.
- To determine if perindopril-induced arterial changes are solely flow-dependent.
- To assess the reversibility of perindopril's effects on arterial and cardiac parameters after drug withdrawal and the persistence of effects after long-term treatment.
Main Methods:
- A single-blind, placebo-controlled study design was employed.
- Patients with sustained essential hypertension received perindopril or placebo.
- Measurements included blood pressure, forearm arterial hemodynamics (including wrist occlusion tests), and echocardiographic parameters.
- Assessments were conducted before, during, and after treatment periods, including a one-year follow-up in some patients.
Main Results:
- Perindopril significantly reduced blood pressure and increased brachial artery diameter, blood flow, and compliance.
- Perindopril treatment led to a smaller reduction in brachial artery diameter during occlusion, suggesting a non-flow-dependent dilation.
- Withdrawal of perindopril led to a return of blood pressure and arterial hemodynamics to baseline, but significantly decreased cardiac mass persisted.
- Long-term perindopril treatment maintained increased arterial compliance and further diminished cardiac mass.
Conclusions:
- Perindopril induces arterial changes through a drug-related relaxation of arterial smooth muscle, not solely flow-dependent dilation.
- There is a differential response between arterial and cardiac changes following long-term perindopril treatment.
- Perindopril offers sustained cardiovascular benefits, including improved arterial function and reduced cardiac mass, in patients with essential hypertension.
Abstract:
Blood pressure, forearm arterial haemodynamics and echocardiographic parameters were studied in patients with sustained essential hypertension before and after administration of the ACE inhibitor, perindopril. In a single blind study versus placebo, perindopril significantly reduced BP and at the same time increased brachial artery diameter, blood flow and compliance. As part of the haemodynamic investigation, a 5 minute wrist occlusion was performed. During this period, blood flow velocity and arterial diameter decreased but the reduction in diameter was smaller with perindopril after one year's treatment showing an increase in brachial artery diameter. This result indicates that the increase in brachial arterial diameter following perindopril could not be explained solely on the basis of a flow dependent dilation. When perindopril was withdrawn after three months of treatment and replaced by placebo for four weeks, BP and forearm arterial haemodynamics returned towards baseline values. However, cardiac mass which was significantly decreased after perindopril remained decreased four weeks after cessation of treatment. In the seven normalised patients, perindopril was continued for one year; arterial compliance remained increased and cardia mass diminished. The study showed that the arterial changes caused by perindopril involved a drug-related relaxation of arterial smooth muscle and that there was a differential response in cardiac and arterial changes following long term treatment.