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ACE-inhibitors and coronary microcirculation

B E Strauer1, M Vogt, W Motz

  • 1Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf.

Basic Research in Cardiology
|January 1, 1993
PubMed
Summary

Arterial hypertension damages coronary microcirculation. ACE-inhibitor enalapril therapy improved coronary flow reserve in hypertensive patients, suggesting it can reverse structural vascular abnormalities.

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Area of Science:

  • Cardiology
  • Vascular Biology
  • Pharmacology

Background:

  • Arterial hypertension frequently impairs coronary microcirculation, leading to angina and positive exercise tests despite normal epicardial arteries.
  • Hypertensive effects on coronary microcirculation involve functional and structural alterations, causing chronic myocardial ischemia.
  • Antihypertensive therapy should target blood pressure, myocardial hypertrophy, and coronary microcirculation improvement.

Purpose of the Study:

  • To clinically evaluate the impact of long-term angiotensin-converting enzyme (ACE) inhibitor enalapril treatment on coronary flow reserve in hypertensive patients.
  • To assess whether enalapril therapy can reverse structural vascular abnormalities in the coronary microcirculation.
  • To determine the extent of coronary microcirculation improvement under clinical conditions.

Main Methods:

  • A study involving hypertensive patients treated with enalapril (10-20 mg/d) for 9-12 months.
  • Coronary microcirculation was assessed by measuring maximal coronary blood flow, minimal coronary resistance, and coronary reserve using dipyridamole.
  • Measurements were taken before and after treatment, with a 1-week drug intermission to evaluate chronic effects.

Main Results:

  • Enalapril treatment led to an approximate 8% decrease in left ventricular (LV) muscle mass.
  • Coronary reserve significantly improved by 48% after enalapril therapy.
  • These improvements suggest a reversal of structural vascular abnormalities in the coronary microcirculation.

Conclusions:

  • Long-term ACE inhibitor therapy, specifically enalapril, can significantly improve coronary flow reserve in hypertensive patients.
  • The observed enhancement in coronary reserve is likely due to the reversal of structural vascular remodeling in the coronary microcirculation.
  • ACE inhibitor therapy holds potential for repairing hypertensive damage to the coronary microcirculation and mitigating chronic ischemic consequences.

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