Normalization of resistance artery structure and left ventricular morphology with a perindopril-based regimen

Twenty-five patients with newly diagnosed or poorly regulated essential hypertension were randomly selected from a larger group referred to hospital. Treatment was initiated with perindopril (4 to 8 mg od). If normotension was not achieved, isradipine (5 to 10 mg od) was added and, if necessary, hydralazine was added. Before treatment and at the end of a nine-month period of normotension (diastolic blood pressure less than 90 mmHg), 24 h blood pressure and echocardiographic measurements were performed and resistance artery structure was determined. Twenty age- and sex-matched normotensives were used as controls. During antihypertensive treatment, mean blood pressure was reduced from 128 +/- 11 to 103 +/- 6 mmHg. Left ventricular mass was reduced from 300 +/- 76 to 198 +/- 54 g. The media:lumen ratio of the resistance arteries decreased from 9.8 +/- 2.6% to 7.8 +/- 1.9%. Control subjects exhibited a media:lumen ratio of the same magnitude (7.9 +/- 2.0). Regression of left ventricular mass correlated significantly with regression of the media:lumen ratio with a coefficient of 0.59 (P < 0.05). Results indicate that a perindopril-based regimen is extremely efficient in normalizing resistance artery and cardiac ventricular structures within one year of treatment. The impact of these findings on the excess cardiovascular morbidity and mortality in arterial hypertension still remains to be demonstrated.