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(Hypertension. 1996;27:1031-1038.)
© 1996 American Heart Association, Inc.
Articles |
Improvement of Coronary Flow Reserve After Long-term Therapy With Enalapril
From the Department of Medicine, Ernst-Moritz-Arndt-University of Greifswald, Cardiovascular Center Karlsburg (W.M.), and Department of Medicine, Heinrich-Heine-University of Duesseldorf (B.E.S.) (FRG).
Correspondence to Wolfgang Motz, MD, Department of Medicine, Ernst-Moritz-Arndt-University, Friedrich-Loeffler-Straße 23, D-17487 Greifswald, FRG.
Abstract To date, no clinical study shows an improvement in coronary flow reserve due to long-term antihypertensive therapy. In view of the contribution of the renin-angiotensin system to the process of hypertensive remodeling of the heart and coronary circulation, angiotensin-converting enzyme (ACE) inhibitors might act as cardioreparative drugs in arterial hypertension. Accordingly, our objective in this investigation was to examine under clinical conditions to what extent long-term antihypertensive treatment with an angiotensin-converting enzyme inhibitor improved the diminished coronary flow reserve in hypertensive patients with microvascular angina pectoris. For the purpose of comparison, we also treated a normotensive control group of 6 patients with hypertrophic nonobstructive cardiomyopathy. Fifteen hypertensive individuals (10 men, 5 women; age, 58±6 years) were treated with enalapril (10 to 20 mg/d; mean, 16.7±4.9 mg/d) for 11 to 13 months. At the end of the treatment period, systolic pressure decreased from 178±14 to 137±12 mm Hg and diastolic pressure from 102±11 to 86±4 mm Hg under ambulatory conditions. Left ventricular muscle mass index decreased by 8%, from 149±32 to 137±28 g/m2 (P<.05). Maximal coronary blood flow after dipyridamole was increased by 43%, from 181±69 to 258±116 mL/min per 100 g (P<.001), and minimal coronary vascular resistance was diminished by 29%, from 0.66±0.23 to 0.47±0.24 mm Hg·min·100 g·mL-1 (P<.001) after enalapril treatment. Consequently, the calculated coronary reserve increased from 2.2±0.6 to 3.3±1.2 (P<.001). After enalapril therapy, the functional class of angina pectoris according to the Canadian classification system had changed from 2.5±0.6 to 1.5±0.6 (P<.01). The maximal working capacity had increased from 23.775±3.970 to 26.255±4.598 J (mean±SE, P<.05). The maximal ST-segment depression at maximal workload was reduced from 0.18±0.02 to 0.06±0.02 mV (mean±SE, P<.01). In summary, long-term therapy with the angiotensin-converting enzyme inhibitor enalapril must be considered a cardioreparative treatment with respect to the coronary microcirculation in hypertensive heart disease.
Key Words: angina pectoris • coronary circulation • hypertrophy, left ventricular • angiotensin-converting enzyme inhibitors • enalapril
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