Assessment of Perindopril's Efficacy on Arterial Distensibility in Mild to Moderate Hypertension
COMPLIOR COLLABORATIVE STUDY GROUP*
Affiliation : * Division of Cardiovascular Disease, Department of Medicine, Faculty of Medicine, Chulalongkom Hospital, Bangkok 10330, ** Division of Cardiovascular Disease, Department of Medicine, Bhumipol Adulyadej Hospital, Bangkok 10210, *** Division of Cardiology, Department of Medicine, Maharaj Nakom Chiang Mai Hospital, Chiang Mai 50202, Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University,Bangkok 10400, ****Hypertension Unit, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, *****Cardiovascular Division, Department of Medicine, Pramongkutklao Hospital, Bangkok 10300, ****** Cardiovascular Division, Department of Medicine, Central Hospital, Bangkok 10100, *******Division of Cardiology, Department of Medicine, Somdejprapinklao Hospital, Bangkok 10600, Thailand.
Objective : Angiotensin Converting Enzyme Inhibitors (ACEis) have been clearly proven to be effective in blood pressure control and haemodynamic control in heart failure patients. More over, there is evidence that ACEis, both in animal models and in humans, also possess the ability to reduce remodeling in cardiovascular structures. Therefore, the reduction of the occurrence of arterial stiffness, leading to an increase in distensibility, is also anticipated.
Method : Other than physically measuring arterial wall, the assessment of Pulse Wave Velocity (PWV) is also a widely used index of arterial distensibility, which deteriorates through the course of remodeling. To determine the efficacy of a particular ACEI, perindopril, in increasing arterial distensibility, thus reducing PWV, a 6-month multi-center study was conducted in 146 patients with mild to moderate hypertension. The study population consisted of 70 men and 76 women, aged 56.36 (SD 9.4, range 28-73) years. 73 patients were newly diagnosed, 65 were treated patients but the blood pressure was not controlled, and 8 were treated patients with their blood pressure controlled but with adverse effects in need of switching treatment regimens.
Results : Mean blood pressure at the beginning of the study was 164.25/97.49 mmHg and 11.71 m/s (SD 2.29 range 7.35-20.12 m/s) in mean PWV. Perindopril was prescribed tritrating from 4 mg/day to 8 mg/day and adding a diuretic. 106 patients completed the study with 76.4 per cent of patients having their blood pressure controlled (Mean Blood pressure 138.6/85.18 mmHg, SD 11.34 and 7.10 Range 110-170/70-110 mmHg) (p<0.05). Mean PWV reduced to 10.56 mls (~9.89%) (SD 1.84 range 7.27-15.96 m/s) (p< 0.05).
Conclusion : Anti-hypertensive treatment with perindopril for 6 months was effective in controlling blood pressure and reducing Pulse Wave Velocity reflecting the increase of arterial dis tensibility.
Keywords : ACE-I, Arterial Distensibility, Perindopril, Pulse Wave Velocity
