Long-term treatment with perindopril ameliorates dobutamine-induced myocardial ischemia in patients with coronary artery disease.
The present study was designed to examine whether long-term blockade of angiotensin-converting enzyme (ACE) with perindopril ameliorates dobutamine-induced myocardial ischemia in patients with coronary artery disease (CAD). Twelve patients with proven CAD were randomly divided in two groups; one group received perindopril (8 mg/day, p.o.) for 3 months and another group served as a control. To evaluate anti-ischemic effects of perindopril, dobutamine stress echocardiography was performed before and 3 months after the treatment in a double-blind manner. Long-term treatment with perindopril significantly ameliorated the dobutamine-induced myocardial ischemia, as evaluated by time to the onset of symptoms, magnitude of electrocardiographic ST-segment changes, and left ventricular wall motion score (all P<0.05). The treatment significantly decreased serum ACE activities (P<0.01) and increased plasma bradykinin concentrations (P<0.05). The extent of reduction of left ventricular wall motion score by perindopril was closely correlated with that of inhibition of serum ACE activities (P<0.01) and with that of increase in plasma bradykinin concentrations (P<0.05). By contrast, no such beneficial changes were noted in the control group. These results provide the first evidence that long-term treatment with perindopril exerts anti-ischemic effects on the myocardial ischemia induced by increased myocardial oxygen demand in patients with CAD.
Morishita
Tsuyoshi
T
Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Tsutsui
Masato
M
Shimokawa
Hiroaki
H
Tasaki
Hiromi
H
Suda
Osamu
O
Kobayashi
Kengo
K
Horiuchi
Masataka
M
Okuda
Haruhito
H
Tsuda
Yuki
Y
Yanagihara
Nobuyuki
N
Nakashima
Yasuhide
Y
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D001920:Bradykinin / Q000097:blood; D003327:Coronary Disease / Q000150:complications*; D004280:Dobutamine / Q000494:pharmacology*; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy*; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D020913:Perindopril / Q000008:administration & dosage / Q000627:therapeutic use*; D013566:Sympathomimetics / Q000494:pharmacology*; D013997:Time Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D013566:Sympathomimetics; D004280:Dobutamine; D007703:Peptidyl-Dipeptidase A; D001920:Bradykinin; D020913:Perindopril