title: Severity of hypertension affects improved resistance artery endothelial function by angiotensin-converting enzyme inhibition.
abstract: The purpose of this study was to determine whether there are differences in the restoration of endothelial function by angiotensin-converting enzyme inhibition based on the severity of hypertension. Forearm blood flow (FBF) was measured in 69 patients with essential hypertension (mild, n = 23; moderate, n = 29; and severe, n = 17 randomly assigned to treatment with either imidapril or amlodipine for 24 weeks in a double-blind fashion during reactive hyperemia and after sublingual administration of nitroglycerin. Imidapril augmented the FBF response to reactive hyperemia after 24 weeks of treatment in the mild and moderate hypertensive groups, but not in the severe hypertensive group. The augmentation of the FBF response to reactive hyperemia induced by imidapril was significantly greater in the moderate hypertensive group than in the mild hypertensive group. Amlodipine did not alter the FBF response to reactive hyperemia. The increase in FBF after the sublingually administered nitroglycerin was similar in all groups. The infusion of NG-monomethyl-l-arginine, a nitric oxide synthase inhibitor, abolished the enhancement of reactive hyperemia in the mild and moderate hypertensive groups treated with imidapril. These findings suggest that the effects of imidapril on endothelial function are affected by the severity of hypertension and that angiotensin-converting enzyme inhibitor-induced augmentation of reactive hyperemia may be due to increased nitric oxide production.
authors.affiliation: First Department of Internal Medicine, Hiroshima University, Faculty of Medicine, Minami-ku, Japan. yhigashi@hiroshima-u.ac.jp
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Higashi
authors.forename: Shota
authors.initials: S
authors.lastname: Sasaki
authors.forename: Keigo
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sasaki
authors.forename: Kensuke
authors.initials: K
authors.lastname: Noma
authors.forename: Keiko
authors.initials: K
authors.lastname: Hara
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsuura
authors.forename: Chikara
authors.initials: C
authors.lastname: Goto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Oshima
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D017311:Amlodipine / Q000494:pharmacology / Q000627:therapeutic use; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D004311:Double-Blind Method; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use; D048289:Imidazolidines; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000378:metabolism; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D012720:Severity of Illness Index; D014655:Vascular Resistance / Q000187:drug effects* / Q000502:physiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007093:Imidazoles; D048289:Imidazolidines; D017311:Amlodipine; C065166:imidapril; D007703:Peptidyl-Dipeptidase A