(Hypertension. 1995;25:474-481.)
© 1995 American Heart Association, Inc.
Articles |
Effect of Antihypertensive Treatment on Small Arteries of Patients With Previously Untreated Essential Hypertension
From the Department of Pharmacology and Danish Biomembrane Research Centre, University of Aarhus, Denmark (N.K.T., C.A., M.J.M.), and the Department of Medicine, University Hospital of South Manchester, West Didsbury, Manchester, England.
Correspondence to Prof M.J. Mulvany, Department of Pharmacology, Aarhus University, Universitetsparken 240, 8000 Aarhus C Denmark.
Abstract In a double-blind randomized trial, the effects of
treatment with an angiotensin-converting enzyme (ACE) inhibitor
(perindopril) and a ß-blocker (atenolol) on small artery structure
were compared in previously untreated essential hypertensive patients.
Subjects (diastolic blood pressure 
100 and 
120 mm Hg) were
randomly assigned to treatment for 12 months with either perindopril
(n=13, 4 to 8 mg/d) or atenolol (n=12, 50 to 100 mg/d); the dosage was
adjusted upward and in some cases combined (n=5, perindopril; n=2,
atenolol) with thiazide diuretic to achieve target blood pressure
(diastolic blood pressure below 90 mm Hg). Before and at the end of
treatment, gluteal biopsies were taken under local anesthetic; from
these biopsies, two small arteries were dissected and mounted on a
myograph for morphometry. The reduction in blood pressure with atenolol
(drop in mean blood pressure 28.4±1.8 mm Hg) was greater than with
perindopril (20.6±1.8 mm Hg, P<.05). Perindopril
treatment caused an increase in small artery diameter (231±14 to
274±13 µm, P<.05) and a reduction in the ratio of media
thickness to lumen diameter (7.94±0.65% to 5.96±0.42%,
P<.05), whereas atenolol had no effect (246±14 to 231±13
µm and 7.14±0.47% to 6.79±0.45%, respectively). The change in
small artery morphology caused by perindopril was not accompanied by
any change in media cross-sectional area, suggesting that the change
was due to "remodeling." The results support the possibility that
treatment with ACE inhibitors causes a greater normalization of the
structure of the resistance vasculature in essential hypertensive
patients than treatment with ß-blockers.
Key Words: antihypertensive therapy • resistance vessels • clinical trials • hypertension, essential
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