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Effect of angiotensin converting enzyme inhibitor on chronic ischemic patients
N Kawakami1, T Yamashita, S Nakano
1Department of Neurosurgery, Yamaguchi University School of Medicine, Japan.
Insights
Long-term treatment with cilazapril improved cerebrovascular reserve capacity (CRC) in patients with cerebral arterial trunk steno-occlusive lesions. This antihypertensive drug did not decrease cerebral blood flow (CBF), unlike calcium blockers.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Hypertension is a common comorbidity with cerebrovascular disease, leading to progressive atheromatous changes and steno-occlusive lesions in cerebral arteries.
- Angiotensin converting enzyme (ACE) inhibitor cilazapril is an antihypertensive drug with potential benefits for cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC).
Purpose of the Study:
- To investigate the long-term effects of cilazapril on CBF and CRC in patients with steno-occlusive lesions of major cerebral arterial trunks.
- To compare the effects of cilazapril with calcium blockers on CBF and CRC in the same patient group.
Main Methods:
- Clinical study utilizing stable xenon computerized tomography (Xe-CT) with acetazolamide challenge to measure CBF and CRC.
- Long-term treatment with cilazapril or calcium blockers in patients with steno-occlusive lesions.
- Comparative analysis of CBF and CRC changes between the two treatment groups.
Main Results:
- Long-term treatment with both cilazapril and calcium blockers did not alter CBF.
- Cilazapril treatment resulted in a significant increase in CRC (p < 0.05).
- Calcium blocker treatment did not lead to significant changes in CRC.
Conclusions:
- Long-term cilazapril treatment is safe concerning CBF in patients with major cerebral arterial trunk occlusive lesions.
- Cilazapril effectively improves CRC in patients with steno-occlusive lesions of the major cerebral arterial trunk.
- Cilazapril demonstrates a superior effect on CRC compared to calcium blockers in this patient population.
Abstract:
Most of patients with cerebrovascular disease are associated with hypertension. Hypertension induces progressive atheromatous changes in cerebral arteries, and often causes steno-occlusive lesions of cerebral arteries. Angiotensin converting enzyme (ACE) inhibitor cilazapril is one of the antihypertensive drugs. It was reported that cilazapril improved resting cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) in experimental studies. In this clinical study, the authors investigated whether long-term treatment with cilazapril could improve CBF and CRC in patients with steno-occlusive lesions of the major cerebral arterial trunk, measured by stable xenon computerized tomography (Xe-CT) with acetazolamide challenge. On the other hand, CBF and CRC in the calcium blocker-treated patients were measured in the same way. CBF did not change after long-term treatment with both cilazapril and calcium blocker. In the cilazapril-treated group, CRC was increased significantly (p < 0.05). However, CRC did not change in the calcium blocker-treated group. It was recognized that long-term treatment with cilazapril did not decrease CBF and improved CRC in patients with occlusive lesions of the major cerebral arterial trunk.