Published Online
on February 21, 2005

A more recent version of this article appeared on April 1, 2005

This Article Full Text (PDF) All Versions of this Article: 45/4/659    most recent 01.HYP.0000153308.91043.97v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rizzoni, D. Articles by Rosei, E. A. Search for Related Content PubMed PubMed Citation Articles by Rizzoni, D. Articles by Rosei, E. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Diabetes High Blood Pressure Hazardous Substances DB ENALAPRIL MALEATE Related Collections Remodeling Hypertrophy Smooth muscle proliferation and differentiation Type 2 diabetes Endothelium/vascular type/nitric oxide

Submitted on September 27, 2004
Revised on November 2, 2004

Effect of Treatment With Candesartan or Enalapril on Subcutaneous Small Artery Structure in Hypertensive Patients With Noninsulin-Dependent Diabetes Mellitus

Damiano Rizzoni^*; Enzo Porteri; Carolina De Ciuceis; Intissar Sleiman; Luigi Rodella; Rita Rezzani; Silvia Paiardi; Rossella Bianchi; Giuseppina Ruggeri; Gianluca E.M. Boari; Maria Lorenza Muiesan; Massimo Salvetti; Francesca Zani; Marco Miclini; and Enrico Agabiti Rosei

From the Departments of Medical and Surgical Sciences (D.R., E.P., C.D.C., I.S., S.P., G.E.M.B., M.L.M., M.S., F.Z., M.M., E.A.R.),Biomedical Sciences and Biotechnology (L.R., R.R., R.B.), and Chemistry (G.R.) University of Brescia, Italy.

^* To whom correspondence should be addressed. E-mail: rizzoni{at}med.unibs.it.

Abstract--Structural alterations of subcutaneous small resistance arteries are associated with a worse clinical prognosis in hypertension and noninsulin-dependent diabetes mellitus (NIDDM). However, no data are presently available about the effects of antihypertensive therapy on vascular structure in hypertensive patients with NIDDM. Therefore, we have investigated the effect of an angiotensin-converting enzyme inhibitor, enalapril, and a highly selective angiotensin receptor blocker, candesartan cilexetil, on indices of subcutaneous small resistance artery structure in 15 patients with mild hypertension and NIDDM. Eight patients were treated with candesartan (8 to 16 mg per day) and 7 with enalapril (10 to 20 mg per day) for 1 year. Each patient underwent a biopsy of the subcutaneous fat from the gluteal region at baseline and after 1 year of treatment. Small arteries were dissected and mounted on a micromyograph and the media-to-internal lumen ratio was evaluated; moreover, endothelium-dependent vasodilation to acetylcholine was assessed. A similar blood pressure-lowering effect and a similar reduction of the media-to-lumen ratio of small arteries was observed with the 2 drugs. Vascular collagen content was reduced and metalloproteinase-9 was increased by candesartan, but not by enalapril. Changes of circulating indices of collagen turnover and circulating matrix metalloproteinase paralleled those of vascular collagen. The 2 drugs equally improved endothelial function. In conclusion, antihypertensive treatment with drugs that inhibit the renin-angiotensin-aldosterone system activity is able to correct, at least in part, alterations in small resistance artery structure in hypertensive patients with NIDDM. Candesartan may be more effective than enalapril in reducing collagen content in the vasculature.

Key words: arteries • diabetes mellitus • hypertrophy • remodeling

This article has been cited by other articles:

				M. Satoh, S. Fujimoto, S. Arakawa, T. Yada, T. Namikoshi, Y. Haruna, H. Horike, T. Sasaki, and N. Kashihara Angiotensin II type 1 receptor blocker ameliorates uncoupled endothelial nitric oxide synthase in rats with experimental diabetic nephropathy Nephrol. Dial. Transplant., December 1, 2008; 23(12): 3806 - 3813. [Abstract] [Full Text] [PDF]

				R. D. Smith and P. J. Levy Review: New techniques for assessment of vascular function Therapeutic Advances in Cardiovascular Disease, October 1, 2008; 2(5): 373 - 385. [Abstract] [PDF]

				B. I. Levy, E. L. Schiffrin, J.-J. Mourad, D. Agostini, E. Vicaut, M. E. Safar, and H. A.J. Struijker-Boudier Impaired Tissue Perfusion: A Pathology Common to Hypertension, Obesity, and Diabetes Mellitus Circulation, August 26, 2008; 118(9): 968 - 976. [Full Text] [PDF]

				F. Feihl, L. Liaudet, B. I. Levy, and B. Waeber Hypertension and microvascular remodelling Cardiovasc Res, May 1, 2008; 78(2): 274 - 285. [Abstract] [Full Text] [PDF]

				C. Savoia, R. M. Touyz, F. Amiri, and E. L. Schiffrin Selective Mineralocorticoid Receptor Blocker Eplerenone Reduces Resistance Artery Stiffness in Hypertensive Patients Hypertension, February 1, 2008; 51(2): 432 - 439. [Abstract] [Full Text] [PDF]

				K. Sonoyama, A. Greenstein, A. Price, K. Khavandi, and T. Heagerty Review: Vascular remodeling: implications for small artery function and target organ damage Therapeutic Advances in Cardiovascular Disease, December 1, 2007; 1(2): 129 - 137. [Abstract] [PDF]

				C. Savoia, R. M. Touyz, and E. L. Schiffrin Response to Are the Eutrophic Effects of Angiotensin Receptor Blockers Real? Hypertension, October 1, 2006; 48(4): E19 - E19. [Full Text] [PDF]

				C. Savoia, R. M. Touyz, D. H. Endemann, Q. Pu, E. A. Ko, C. De Ciuceis, and E. L. Schiffrin Angiotensin Receptor Blocker Added to Previous Antihypertensive Agents on Arteries of Diabetic Hypertensive Patients Hypertension, August 1, 2006; 48(2): 271 - 277. [Abstract] [Full Text] [PDF]

				D. Rizzoni, S. Paiardi, L. Rodella, E. Porteri, C. De Ciuceis, R. Rezzani, G. E. M. Boari, F. Zani, M. Miclini, G. A. M. Tiberio, et al. Changes in Extracellular Matrix in Subcutaneous Small Resistance Arteries of Patients with Primary Aldosteronism J. Clin. Endocrinol. Metab., July 1, 2006; 91(7): 2638 - 2642. [Abstract] [Full Text] [PDF]

				P. Brassard, F. Amiri, and E. L. Schiffrin Combined Angiotensin II Type 1 and Type 2 Receptor Blockade on Vascular Remodeling and Matrix Metalloproteinases in Resistance Arteries Hypertension, September 1, 2005; 46(3): 598 - 606. [Abstract] [Full Text] [PDF]