From the First Department of Internal Medicine (Y.H., S.S., H.M., G.K.)
and the Department of Clinical Laboratory Medicine (T.O., Y.N., M.K.),
Hiroshima University School of Medicine, Japan.
Correspondence to Yukihito Higashi, MD, PhD, First Department of Internal Medicine, Hiroshima University School of Medicine, 1–2-3 Kasumi, Minami-ku, Hiroshima 734, Japan. E-mail yhigashi{at}mcai.med.hiroshima-u.ac.jp
Abstract—Endothelial
function has been shown to be impaired in patients with essential
hypertension. The purpose of the present study was to determine
whether antihypertensive drug therapy improves impaired
endothelium-dependent renal vasorelaxation in essential
hypertensive patients without atherosclerosis. We
evaluated the effects of intravenous infusion of
L-arginine (500 mg/kg given over 30 minutes) on systemic
and renal hemodynamics in 27 patients with mild to
moderate essential hypertension who were randomly assigned to treatment
with either the angiotensin-converting enzyme
inhibitor imidapril or the calcium antagonist
amlodipine for 12 weeks in a double-blind fashion. After the 12 weeks,
the decrease in blood pressure was similar in the imidapril (n=14) and
amlodipine (n=13) groups. The increase in renal plasma flow was also
similar in both groups. L-Arginine–induced renovascular
relaxation was increased by imidapril (renal plasma flow, 9.6±5.1% to
14.4±7.4%; renal vascular resistance, -10.4±8.1% to -16.7±9.2%,
P<0.05, respectively) but not by amlodipine. Urinary
excretion of nitrite/nitrate in response to L-arginine was
significantly increased by imidapril (90±29% to 134±63%,
P<0.05) but remained unchanged by amlodipine. These
findings suggest that angiotensin-converting enzyme
inhibition improves the impaired endothelium-dependent
renovascular relaxation in patients with essential hypertension due to
the increase in nitric oxide production and that the reduction
in blood pressure with a calcium antagonist does not play a
major role in the potentiation of L-arginine/nitric
oxide–mediated effects.
© 1998 American Heart Association, Inc.
Scientific Contributions
Angiotensin-Converting Enzyme Inhibition, But Not Calcium Antagonism, Improves a Response of the Renal Vasculature to L-Arginine in Patients With Essential Hypertension
Key Words: angiotensin-converting enzyme inhibitor • calcium antagonist • nitric oxide • endothelium • kidney • hypertension, essential
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