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Therapeutic benefits of cilazapril in patients with syndrome X
I Nalbantgil1, R Onder, A Altintig
1Ege University Medical School, Izmir, Turkey.
Insights
Cilazapril treatment improved exercise ECG test results in patients with Syndrome X, suggesting a benefit in managing this condition. This angiotensin-converting enzyme inhibitor may positively impact coronary microcirculation.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Syndrome X pathophysiology involves potential microvascular dysfunction and abnormal vasodilation.
- Angiotensin II plays a role in vascular resistance, making ACE inhibitors potential therapeutic agents.
Purpose of the Study:
- To evaluate the long-term therapeutic effect of cilazapril in patients diagnosed with Syndrome X.
- To investigate if cilazapril can improve exercise capacity and reduce ischemic changes in Syndrome X.
Main Methods:
- A randomized, double-blind, placebo-controlled crossover trial involving 18 Syndrome X patients.
- Patients received cilazapril (2 x 2.5 mg) or placebo for 3 weeks, followed by crossover, with exercise ECG tests performed.
- A 1-week washout period preceded the treatment phases.
Main Results:
- Cilazapril significantly reduced ST segment depression during exercise compared to placebo.
- Total exercise time and time to 1 mm ST depression were significantly prolonged with cilazapril.
- No significant difference in rate pressure products at peak exercise or 1 mm ST depression was observed.
Conclusions:
- Cilazapril demonstrates a beneficial therapeutic effect in managing Syndrome X.
- The mechanism may involve modulation of coronary tone at the microcirculation level.
- Further research into ACE inhibitors for microvascular angina is warranted.
Objectives:
Although the pathophysiology of syndrome X (angina pectoris, positive ECG test findings and normal coronary arteriogram) is unclear, it is generally accepted that intracellular metabolic changes resulting from abnormal constriction of prearteriolar vessels due to endothelium-dependent vasodilation abnormalities may play a role in the pathogenesis. We established the effect of long-term treatment with cilazapril, an angiotensin-converting enzyme inhibitor, which prevents the effect of angiotensin II in the tonic control of vascular resistance.
Methods:
18 patients (15 women and 3 men, mean age 43.2 +/- 4.6 years) with syndrome X were included in this study. A randomized double-blind crossover placebo-controlled trial was done. After a 1-week washout period, patients received either cilazapril 2 x 2.5 mg or placebo for 3 weeks, followed by 3 weeks of the other therapy. At the end of two periods, an exercise ECG test (modified Bruce protocol) was employed.
Results:
The magnitude of ST segment depression was significantly decreased during treatment with cilazapril compared with placebo. On the other hand, total exercise time and time to 1 mm ST segment depression were significantly prolonged by cilazapril. However, rate pressure products were not significantly different at peak exercise at or at 1 mm of ST segment depression during both therapies.
Conclusion:
Cilazapril exerted a beneficial therapeutic effect in cases with syndrome X. The possible mechanism of this effect may be a modulation of coronary tone at the microcirculation level.