[Restoration of normal coronary vasomotricity after intravenous infusion of angiotensin converting-enzyme inhibitor (perindoprilat) in hypertensive patients].
We have previously shown that in hypertensive patients, the response of normal coronary arteries to sympathetic stimulation evoked by the cold-pressor test (CPT), and the endothelial-mediated flow-dependent coronary vasodilation were impaired. The immediate effects of the converting-enzyme inhibitor perindoprilat (PER) have been evaluated in 10 untreated hypertensive patients with angiographically normal coronary arteries and results have been compared to the normal responses of 10 control subjects. Diameter changes of proximal left anterior descending coronary artery (pLAD) and coronary flow velocity in distal LAD have been measured at baseline, during CPT, during recontrol, and after 10 mg papaverine (PAP) injection in the mid portion of the LAD. Measures have been repeated after intravenous infusion of 1 mg PER, and at the end of the procedure after 2 mg intracoronary injection of isosorbide dinitrate (ISDN). Left ventricular dimensions and systolic function, total cholesterol, triglycerides, HDL and LDL-cholesterol were within the normal range. In hypertensive patients before PER, pLAD constricted in response to the CPT and no diameter change was observed after PAP, despite the increase in flow velocity in the 2 conditions (+63 +/- 27%, and +412 +/- 77%, respectively; all p < 0.001). In control subjects, pLAD dilated significantly in these 2 conditions. In hypertensive patients after PER, pLAD dilated similarly to control subjects in the 2 conditions. Endothelium-independent coronary dilation to ISDN was comparable in the 2 groups of patients. In conclusion, PER restores a normal coronary response both to sympathetic stimulation due to CPT and to flow increase in hypertensive patients with angiographically normal coronary arteries and without any other coronary risk factors.
Antony
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Service d'explorations fonctionnelles, INSERM U251, hôpital Louis-Mourier, Colombes.
Lerebours
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Nitenberg
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A
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D003331:Coronary Vessels / Q000187:drug effects*; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007211:Indoles / Q000494:pharmacology*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D014666:Vasomotor System / Q000187:drug effects* / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors; D007211:Indoles; C053500:perindoprilat
Rétablissement d'une vasomotricité coronaire normale après injection intraveineuse d'un inhibiteur de l'enzyme de conversion (périndoprilate) chez les sujets hypertendus.