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Effect of long-term angiotensin-converting enzyme inhibition on endothelial function in patients with the
P J Bijlstra1, P Smits, J A Lutterman
1Department of Internal Medicine, University Hospital Nijmegen, The Netherlands.
Insights
Long-term perindopril treatment in patients with type 2 diabetes and hypertension did not improve endothelium-dependent vasodilation. However, it did reduce blood pressure and improve forearm vascular resistance after ischemia.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Endocrinology
Background:
- Cardiovascular risk factors like hypertension and diabetes impair blood vessel function.
- Patients with type 2 diabetes often have multiple clustered risk factors.
- Endothelium-dependent vasodilation is crucial for vascular health.
Purpose of the Study:
- To investigate if long-term perindopril treatment improves endothelium-dependent vasodilation in type 2 diabetes patients with hypertension.
- To assess the impact of perindopril on vascular responses to vasodilator stimuli.
Main Methods:
- 10 patients with type 2 diabetes and hypertension were studied.
- Forearm blood flow (FBF) was measured using plethysmography in response to ischemia, methacholine (endothelium-dependent), and sodium nitroprusside (endothelium-independent).
- Measurements were repeated after 6 months of perindopril treatment (4-8 mg/day).
Main Results:
- Perindopril significantly reduced blood pressure (19/10 mm Hg).
- No significant improvement was observed in the maximal vasodilation response to methacholine or sodium nitroprusside.
- Perindopril decreased forearm vascular resistance (FVR) after ischemic stimulus (6.5 to 4.8 U).
Conclusions:
- Perindopril effectively lowers blood pressure in patients with type 2 diabetes and hypertension.
- The drug did not improve endothelium-dependent or independent vasodilation in this cohort.
- Perindopril showed a beneficial effect on vascular resistance following ischemia.
Abstract:
Cardiovascular risk factors such as hypertension, diabetes, and dyslipemia are associated with an impaired endothelium-dependent vasodilation. In patients with type 2 diabetes mellitus, these risk factors are frequently clustered. We investigated whether long-term treatment with the angiotensin-converting enzyme (ACE) inhibitor perindopril can improve endothelium-dependent vasodilation in this particular group of patients. We selected 10 patients with type 2 diabetes and hypertension (age 59.4 +/- 3.2 years, body mass-index 29.7 +/- 1.5 kg.m-2, blood pressure 169 +/- 6/92 +/- 1 mm Hg, total cholesterol 6.6 +/- 0.3 mM). Using venous occlusion plethysmography, we recorded the increases in forearm blood flow (FBF) in response to three vasodilator stimuli: (a) 5 min of forearm ischemia, (b) infusion of the endothelium-dependent vasodilator methacholine (Mch) into the brachial artery (0.03, 0.3, and 1.0 micrograms/min/100 ml), and (c) intraarterial infusion of the endothelium-independent vasodilator sodium nitroprusside (SNP 0.06, 0.2, 0.6 microgram/min/100 ml). This procedure was repeated after 6 months of treatment with perindopril 4-8 mg/day. Forearm vascular resistance (FVR) was calculated by the quotient of the mean arterial pressure (MAP) and the FBF. Perindopril reduced blood pressure (BP) by 19/10 mm Hg (p < 0.05) and increased baseline FVR, but improved neither the maximal percentage decrease in vascular resistance induced by Mch (from -80 +/- 2 to -82 +/- 2%) nor that induced by SNP (from -73 +/- 3 to -72 +/- 3%). Perindopril decreased the FVR reached after the ischemic stimulus from 6.5 +/- 1.2 to 4.8 +/- 0.6 U (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)