Comparison of the effect of perindopril and acebutolol on cerebral hemodynamics in hypertensive patients.
OBJECTIVE
The aim of the study was to compare effect of perindopril (4 mg once a day) versus acebutolol (400 mg once a day) on cerebral hemodynamics in hypertensive patients.


METHODS
Thirty untreated patients with mild-to-moderate hypertension were studied. Drug influences on Doppler-derived parameters from the cerebral blood flow (CBF) velocity wave form were evaluated in a randomized, double blind, cross-over, placebo controlled study. The mean CBF velocity, pulsatility index (PI), cerebrovascular resistance and index of CBF were calculated from concomitant transcranial Doppler measurements and systemic blood pressure.


RESULTS
Acebutolol and perindopril significantly decreased systolic, diastolic and mean blood pressure in relation to placebo. The mean value of CBF velocity increased to a comparable level after both drugs (54.9 +/- 9.1 cm/s on placebo vs 62.8 +/- 14.5 cm/s on perindopril p<0.01 and 61.4 +/- 9.2 cm/s on acebutolol, p<0.01). Also, the cerebrovascular resistance index decreased similarly after both drugs (2.26 +/- 0.35 on placebo vs 1.68 +/- 0.42 on perindopril p<0.01 and 1.7 +/- 0.36 on acebutolol p<0.01). The calculated CBF index increased significantly after each drug (25.23 +/- 7.99 on placebo vs 33.98 +/- 11.23 p<0.01 on perindopril and 30.90 +/- 8.04 on acebutolol p<0.01). However, perindopril augmented the CBF index more effectively than acebutolol (p<0.05).


CONCLUSIONS
Among patients with mild-to-moderate hypertension both acebutolol and perindopril beneficially decreased cerebrovascular resistance and increased the CBF index in comparison with placebo. The increase of CBF index was greater after perindopril than acebutolol, which suggests a more significant improvement in cerebral perfusion by perindopril. The non-invasive transcranial Doppler ultrasonography method of CBF velocity measurement may contribute to choosing optimal antihypertensive therapies and to monitor their effect.
Pieniazek
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1st Department of Internal Medicine, Collegium Medicum Jagiellonian University, Kraków, Poland.
Dimitrow
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PP
Jasiński
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D000070:Acebutolol / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use*; D017585:Ultrasonography, Doppler, Transcranial
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000070:Acebutolol; D020913:Perindopril