Document Detail

Presence of cardiovascular structural changes in essential hypertensive patients with coronary microvascular disease and effects of long-term treatment.
MedLine Citation:
PMID:  8722438     Owner:  NLM     Status:  MEDLINE    
In asymptomatic essential hypertensive patients with angiographically normal coronary arteries and without left ventricular hypertrophy, dipyridamole-induced ischemic-like ST segment depression may be a marker of coronary microvascular disease. In this study we evaluated, first, whether this cardiac abnormality is linked to structural or functional vascular abnormalities, and second, the effect of antihypertensive treatment by 12-month administration of the angiotensin converting enzyme (ACE) inhibitor captopril (50 mg twice a day orally). In essential hypertensives with dipypridamole echocardiography stress test (DET) (DET+, n = 8) and without (DET-, n = 8) ST segment depression greater than 0.1 mV during intravenous dipyridamole infusion (0.84 mg/kg over 10 min), we studied the forearm blood flow (FBF, venous plethysmography, mL/100) modifications induced by intrabrachial acetylcholine (Ach) (0.15, 0.45, 1.5, 4.5, 15 micrograms/100 mL/min x 5 min each), an endothelium-dependent vasodilator, and by sodium nitroprusside (SNP) (1, 2, 4 micrograms/100 mL/min x 5 min each), a smooth muscle cell relaxant compound. Minimal forearm vascular resistances (MFVR), an index of arteriolar structural changes, were also calculated. Both Ach and SNP caused greater vasodilation in DET- as compared to DET+ while MFVRs were lower in DET- compared to DET+. After treatment, both DET+ and DET- patients showed a significant and similar reduction in blood pressure and left ventricular mass index, while vasodilation to acetylcholine and sodium nitroprusside was increased only in the DET+ group. In addition, forearm minimal vascular resistances were significantly reduced only in DET+ patients, who showed disappearance of dipyridamole-induced ischemic-like ST segment depression. In conclusion, these data confirm that essential hypertensive patients with microvascular coronary disease are characterized by the presence of structural changes in the forearm vascular bed. Our results also indicate that both cardiac and forearm vascular abnormalities can be reversed by antihypertensive treatment with an ACE inhibitor.
A Virdis; L Ghiadoni; A Lucarini; V Di Legge; S Taddei; A Salvetti
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of hypertension     Volume:  9     ISSN:  0895-7061     ISO Abbreviation:  Am. J. Hypertens.     Publication Date:  1996 Apr 
Date Detail:
Created Date:  1996-09-26     Completed Date:  1996-09-26     Revised Date:  2009-02-24    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  361-9     Citation Subset:  IM    
I Clinica Medica, University of Pisa, Italy.
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MeSH Terms
Acetylcholine / pharmacology
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Captopril / therapeutic use*
Coronary Circulation / drug effects*
Dipyridamole / diagnostic use
Forearm / blood supply
Hypertension / drug therapy*,  ultrasonography
Hypertrophy, Left Ventricular / drug therapy
Microvascular Angina / drug therapy,  ultrasonography
Middle Aged
Vascular Resistance / drug effects
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 51-84-3/Acetylcholine; 58-32-2/Dipyridamole; 62571-86-2/Captopril
Comment In:
Am J Hypertens. 1996 Apr;9(4 Pt 1):406-8   [PMID:  8722445 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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