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Normalization of structural cardiovascular changes during antihypertensive treatment with a regimen based on the
I Sihm1, A P Schroeder, C Aalkjaer
1Department of Medicine and Cardiology, Aarhus University Hospital, Denmark.
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Perindopril-based treatment effectively normalized resistance artery structure and reduced left ventricular hypertrophy in essential hypertension patients within one year. This study highlights perindopril
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hypertension Research
Background:
- Untreated essential hypertension leads to left ventricular hypertrophy (LVH) and vascular structural changes.
- Assessing the impact of antihypertensive therapy on vascular remodeling is crucial.
Purpose of the Study:
- To evaluate the effect of perindopril-based therapy on the media:lumen ratio of resistance vessels.
- To determine the impact of perindopril-based therapy on left ventricular mass in essential hypertension.
Main Methods:
- Twenty-five essential hypertension patients received perindopril-based treatment for 9 months.
- Subcutaneous gluteal biopsies assessed media:lumen ratio using a myograph.
- Echocardiography measured left ventricular mass.
Main Results:
- Mean media:lumen ratio decreased significantly (p < 0.05).
- Left ventricular mass significantly reduced (p < 0.001).
- A correlation was found between changes in left ventricular mass index and media:lumen ratio (r = 0.62, p < 0.01).
Conclusions:
- Perindopril-based regimens normalize resistance artery structure and LVH in essential hypertension.
- These vascular and cardiac structural improvements occur within one year of treatment.
- Further investigation is needed on the clinical impact on cardiovascular morbidity and mortality.
Abstract:
Untreated essential hypertension is associated with left ventricular hypertrophy (LVH) and structural changes in resistance vessels. The aim of this study was to establish the effect of perindopril based antihypertensive therapy on media thickness to lumen diameter (media:lumen) ratio of peripheral resistance vessels and left ventricular mass in essential hypertension. Twenty-five patients with newly diagnosed or poorly regulated essential hypertension were treated with perindopril. Insufficient treatment response (DBP > 90 mmHg) led to addition of isradipine, and hydralazine was used as a tertiary drug if necessary. Gluteal subcutaneous biopsies were taken surgically at baseline and after 9 months of successful treatment. Two small resistance arteries were isolated and mounted in a small vessel myograph, and media:lumen ratio (%) was measured under standardized conditions. Left ventricular mass was determined by echocardiography. Mean (SD) media:lumen ratio decreased from 9.8 (2.6) % to 7.8 (1.9) % (p < 0.05), while left ventricular mass decreased from 299 (75) g to 199 (53) g (p < 0.001). Correlation was found between changes in left ventricular mass index and media:lumen ratio (r = 0.62, p < 0.01). It is concluded that a perindopril based regimen efficiently normalizes resistance artery structure and left ventricular hypertrophy in essential hypertension within one year of treatment. The impact of these findings on the excess cardiovascular morbidity and mortality in arterial hypertension remains to be investigated.