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Stable improvement in large artery compliance after long-term antihypertensive treatment with enalapril
N De Luca1, B Ricciardelli, G Rosiello
1Clinica Medica, Facoltà di Medicina, Università di Napoli, Italy.
Insights
Enalapril, unlike atenolol, improved forearm hemodynamics in hypertensive patients, reducing vascular resistance and increasing artery size and compliance. These positive effects persisted after treatment withdrawal, suggesting potential arterial remodeling.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Physiology
Background:
- Essential hypertension is a prevalent cardiovascular condition.
- Peripheral hemodynamics play a crucial role in blood pressure regulation.
- Understanding drug-specific effects on vascular function is vital for hypertension management.
Purpose of the Study:
- To compare the effects of enalapril and atenolol on peripheral hemodynamics in patients with essential hypertension.
- To assess the impact of these antihypertensive treatments on vascular resistance, brachial artery diameter, flow, and compliance.
- To evaluate the persistence of hemodynamic changes after drug withdrawal.
Main Methods:
- A study involving 12 patients with mild to moderate essential hypertension.
- Utilized 2-D pulsed Doppler flowmetry to measure peripheral hemodynamics.
- Assessed patients at baseline, after 6 months of enalapril or atenolol treatment, and 2 weeks post-treatment.
Main Results:
- Both enalapril and atenolol effectively lowered blood pressure.
- Enalapril significantly reduced vascular resistance and increased brachial artery diameter, flow, and compliance.
- Atenolol did not significantly alter these forearm hemodynamic parameters.
- Improvements in vascular resistance and compliance persisted in the enalapril group after a 2-week washout period.
Conclusions:
- Enalapril demonstrates superior effects on peripheral hemodynamics compared to atenolol in hypertensive patients.
- Enalapril's ability to improve vascular compliance and resistance may indicate a reversal of structural arterial changes.
- These findings suggest enalapril may offer benefits beyond blood pressure reduction through vascular remodeling.
Abstract:
In 12 patients with mild or moderate essential hypertension we assessed by 2-D pulsed Doppler flowmetry the influence of a 6-month effective treatment with enalapril or atenolol on peripheral hemodynamics. The patients were studied in control conditions, at the end of the 6-month pharmacologic treatment, and 2 weeks after the withdrawal of the therapy. In spite of a comparable fall in blood pressure, the effects of the two drugs on forearm hemodynamics were quite different. Enalapril induced a fall in vascular resistance and an increase in brachial artery diameter, flow, and compliance, while atenolol failed to modify all these parameters. In the enalapril group the improvement in forearm vascular resistance and brachial artery compliance persisted after the 2-week washout period. This latter observation raises the possibility that enalapril may reverse structural changes in the large arteries.