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Trandolapril in patients with essential hypertension: effects on vascular and cardiac structural changes
V Rendina1, G Iaccarino, R Russo
1Department of Internal Medicine, School of Medicine, Federico II University, Naples, Italy.
Insights
Trandolapril, an angiotensin-converting enzyme inhibitor, effectively lowers blood pressure and improves heart and vascular function in hypertensive patients. This antihypertensive therapy reverses structural changes in both the heart and blood vessels, persisting even after treatment cessation.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Elevated arterial pressure leads to detrimental cardiac and vascular remodeling.
- Reversal of these structural changes is a key goal in antihypertensive therapy.
- Prognostic value of regression in cardiac and vascular abnormalities requires further study.
Purpose of the Study:
- To evaluate the effects of trandolapril on blood pressure, cardiac function, and vascular structure in patients with essential hypertension.
- To assess the persistence of these effects after treatment withdrawal.
- To investigate the potential of trandolapril to reverse left ventricular hypertrophy and vascular remodeling.
Main Methods:
- A study involving patients with untreated mild-to-moderate essential hypertension and left ventricular hypertrophy.
- Administration of trandolapril, an angiotensin-converting enzyme inhibitor.
- Assessment of hemodynamic parameters, ventricular function, and vascular compliance/diameter via plethysmography and other methods, with follow-up after 1-month withdrawal.
Main Results:
- Trandolapril reduced blood pressure by decreasing total peripheral resistance.
- Significant improvements in systolic and diastolic ventricular function were observed.
- Long-term trandolapril treatment reversed left ventricular hypertrophy and structural vascular changes in the forearm and brachial artery, with effects persisting after withdrawal.
Conclusions:
- Trandolapril effectively lowers blood pressure and improves cardiac function in hypertensive individuals.
- The drug demonstrates a capacity to reverse structural abnormalities in both the heart and vasculature.
- Observed improvements in cardiac and vascular function persist after a 1-month withdrawal period, suggesting lasting structural reversal.
Abstract:
Elevated arterial pressure levels increase the hemodynamic load on heart and vessels, thus leading to functional and structural abnormalities. Because cardiac and vascular changes increase the risk of cardiovascular disease, their reversal is an important target of antihypertensive therapy, even though the prognostic value of this regression has not been fully established. In patients with untreated mild-to-moderate essential hypertension and left ventricular hypertrophy, trandolapril, a new angiotensin-converting enzyme inhibitor, reduces blood pressure by decreasing total peripheral resistance and improves both systolic and diastolic ventricular function. The latter effect is not only functional in nature because, after long-term antihypertensive treatment, the improvement in diastolic ventricular function is detectable also after 1-month withdrawal of trandolapril. The concurrent reversal of left ventricular hypertrophy may contribute to the improved left ventricular diastolic function. However, plethysmographic studies suggest that long-term antihypertensive treatment with trandolapril is also able to reverse structural vascular changes in the forearm vascular bed, because after 1-month washout forearm peripheral resistance also is lower than in control conditions. Finally, in hypertensive patients, trandolapril induces significant increases in brachial artery compliance and diameter that persist after 1 month of withdrawal from treatment. The latter observation suggests that trandolapril also is able to reverse the structural changes of the large artery wall.(ABSTRACT TRUNCATED AT 250 WORDS)