Daniel J Piñeiro | PubMed Health

PubMed2006

Continuous improvement of arterial compliance beyond blood pressure decrease after 5 years of antihypertensive treatment.

Pulse wave velocity is a reliable marker of arterial compliance. Stiffness of large and elastic arteries leads to a faster propagation of pulse wave. The aim of this study was to evaluate changes in arterial distensibility using antihypertensive drugs. This treatment focused on the inhibition of the renin-angiotensin-aldosterone system and the changes produced in blood pressure. Measurements were taken at baseline and throughout 60 months in 66 previously untreated hypertensive patients (22 men and 44 women, aged 54 +/- 9.5 years, range 38-73 years at baseline). All patients received either angiotensin-converting enzyme inhibitors or, in case of adverse effects, angiotensin receptor blockers. To control blood pressure, diuretics, calcium channel blocking agents, or beta blockers were added when appropriate. Statistical analysis was performed by means of ANOVA with alpha = 0.05. Systolic and diastolic blood pressure decreased during the first year without significant changes thereafter. There were no significant changes in pulse pressure. Pulse wave velocity showed a continuous and significant decrease throughout the follow-up period, but its reduction since the third year was more evident than the decrease in systolic and diastolic blood pressure (p < 0.0001 for both). This observation could be related to changes in arterial remodeling probably due to angiotensin-converting enzyme inhibition or renin angiotensin system blockade. Further investigations are needed to establish this relationship.

Adult↗

PubMed2002

[Pulse wave velocity and urinary albumin excretion in hypertensive patients treated with perindopril].

Systolic and diastolic blood pressures and urinary albumin excretion (UAE) have been recognized as predictors for cardiovascular risk. Furthermore, arterial compliance (AC) disorders assessed by increased aortic pulse wave velocity (PWV) are closely related to changes in blood pressure and strongly correlated with cardiovascular mortality and presence or extent of atherosclerosis. Our purpose in the present study was to determine a relationship between AC using PWV and UAE in a group of non-smoking patients with essential hypertension, and the level of interaction of ACE inhibition on these two variables. A total of 70 non-smoking never treated hypertensive patients (33 men and 37 women), aged 50 +/- 7 years (range 35-69), have been enrolled in this study. All of them underwent PWV by a computerized device (Complior) and UAE determination by radial immunodiffusion method, on baseline and after six months of treatment with perindopril (4.6 +/- 1.4 mg/day). We have found a significant decrease of systolic blood pressure (160.2 +/- 10.6 vs. 131.9 +/- 7.1 mmHg, p < 0.01), diastolic blood pressure (100.6 +/- 5 vs. 81.6 +/- 4.8 mmHg, p < 0.01), PWV (13.4 +/- 1 vs. 9.1 +/- 0.9 m/sec, p < 0.01), and UAE (42.2 +/- 19.3 vs. 11.1 +/- 3.6 mg/day, p < 0.01) at the end of the sixth month when they were compared to baseline values. Furthermore, renal function was also improved by the treatment at the end of the study as illustrated by creatinine clearance (87.5 + 22.5 vs. 102.1 + 23.5 ml/min, p < 0.01). Moreover, a high positive correlation between UAE and PWV at the beginning of the study (r = 0.81; p < 0.01) and after six months of treatment (r = 0.66; p < 0.01) was observed. In addition, PWV vs. UAE, differences between sixth month and baseline have shown a high correlation (r = 0.67; p < 0.01) and using a multiple regression test we found that PWV (t ratio 5.76; p < 0.001) was the most important and significant independent variable that correlates with UAE. These results suggest the existence of a real link between UAE and AC in non-smoking patients with arterial hypertension, and that ACE inhibition can similarly modify these two parameters.

Adult↗