Angiotensin-I Converting Enzyme Inhibitor Improves Decreased Endothelial Function in Elderly Hypertensive Patients with Arteriosclerosis Obliterans
Endothelial function in elderly hypertensive patients with arteriosclerosis obliterans (ASO) has not been evaluated. In this study, we examined whether endothelial function is impaired, and whether antihypertensive agents affect the vasodilatory responses, in elderly hypertensive patients (83 + 8 years) without (n=46) and with (n=24) ASO (ankle-brachial pressure index <0.2). Patients were treated with monotherapy of either temocapril (2 mg, 14 ASO patients and 26 non-ASO patients) or amlodipine (2.5 mg, 10 ASO patients and 20 non-ASO patients) for 6 months. Endothelia function was determined by flow-mediated endothelium-dependent vasodilation during reactive hyperemia after 5 minutes of cuff occlusion (MAX-RH) in the legs and forearms. Not only the MAX-RH in 35 ASO legs (4.7 ± 1.8 ml/min/100ml)Å@but also the value in 13 non-ASO legs (21.0 ±5.0) in the ASO patients were significantly (p<.001 and p=.037) decreased compared to the value in 92 legs in age- and sex-matched control hypertensive subjects (24.1 ±45). Moreover, the MAX-RH in the right forearm in the 24 ASO patients (23.3 ±4.4) was significantly (p=.003) decreased compared to that in the 46 control subjects (26.5 + 3.9). Blood pressure was similarly decreased by the treatment with temocapril or amlodipine. Response to nitroglycerin (0.3 mg) was not changed by either drug. Treatment with temocapril significantly improved the MAX-RH of not only legs (27.3 ±4.5) and forearm (28.1±3.6) in control hypertensive subjects, but also ASO legs (5.7 ±1.5), non-deseased legs (25.3±2.6), and forearm (25.8±3.8) in the ASO patients. However, treatment with amlodipine did not affect the MAX-RH. These results indicate that generalized endothelial function is decreased in elderly hypertensive patients with ASO, and treatment with the angiotensin-converting enzyme inhibitor temocapril improves the decreased vasodilatory response to reactive hyperemia, suggesting its beneficial effect on endothelial function in elderly hypertesive patients with ASO.