Changes in arterial structure and function under trandolapril-verapamil combination in hypertension.
OBJECTIVE
Converting enzyme inhibition and calcium blockade alter large arteries in hypertension. However, the heterogeneity of the response according to the site of cardiovascular measurements has never been investigated.


METHODS
In a double-blind study, we compared for 180 days 3 hypertensive patient groups treated with verapamil, trandolapril, or their combination. Using echo-Doppler technique and applanation tonometry, we independently measured mean pressure, local pulse pressure, arterial diameter, and distensibility at 3 arterial sites (brachial and common carotid arteries and abdominal aorta), as well as cardiac and carotid wall structure.


RESULTS
Mean and pulse pressure decreased significantly to a greater extent with the drug combination. Regarding arterial and cardiac hemodynamics, significant and similar changes were noted in the 3 groups: decreases in abdominal aorta and carotid but not brachial diameter; increases in carotid artery, abdominal aorta, and brachial distensibility even after adjustment to mean blood pressure reduction; and more substantial regression of cardiac mass than carotid wall thickness.


CONCLUSIONS
This study shows that both compounds and more significantly combination therapy decreased mean and pulse pressures measured independently and that the changes in diameter, thickness, and stiffness were influenced primarily by the site of cardiovascular measurements, resulting in a predominant increase in distensibility of muscular arteries, little change in carotid wall thickness, but a significant regression of cardiac hypertrophy.
Topouchian
J
J
Department of Internal Medicine, Broussais Hospital, Paris, France.
Asmar
R
R
Sayegh
F
F
Rudnicki
A
A
Benetos
A
A
Bacri
A M
AM
Safar
M E
ME
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000473:pathology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D007211:Indoles / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014700:Verapamil / Q000008:administration & dosage*
D000959:Antihypertensive Agents; D007211:Indoles; D014665:Vasodilator Agents; C052035:trandolapril; D014700:Verapamil