Long-term angiotensin-converting enzyme inhibitor perindopril therapy improves cerebral perfusion reserve in patients with previous minor stroke.
OBJECTIVE
Angiotensin-converting enzyme (ACE) inhibitor-based therapy reduces the recurrence of stroke. The present study assessed the effects of long-term ACE inhibitor therapy on cerebral circulation in patients with previous minor stroke.


METHODS
After a run-in period, 19 patients were randomized to ACE inhibitor therapy (n=9; 4 mg of perindopril daily; mean age, 64+/-8 years; mean systolic/diastolic blood pressure [BP]+/-SD, 133+/-12/77+/-9 mm Hg) or placebo therapy (n=10; mean age, 66+/-9 years; mean BP, 139+/-10/78+/-8 mm Hg). Cerebral blood flow (CBF) was measured during hypercapnia, normocapnia, and hypocapnia using a positron emission tomography with H2(15)O at entry into the study and after 3 to 12 months. Cerebral perfusion reserve (CPR) was defined as percent CBF response to a 1 mm Hg change in arterial partial pressure of CO2 between hypercapnia and hypocapnia.


RESULTS
Systolic/diastolic BP and CBF during normocapnia showed no significant changes between entry and completion of the trial in the perindopril and placebo groups. Mean value of CPR showed a significant increase in the perindopril group (from 3.7+/-1.7%/mm Hg to 4.8+/-1.7%/mm Hg; P<0.05) but not in the placebo group (from 4.1+/-0.8%/mm Hg to 4.2+/-0.6%/mm Hg; NS). Statistical parametric mapping analysis also showed global and significant increase (P<0.01, uncorrected) in CPR in the perindopril group alone.


CONCLUSIONS
Long-term ACE inhibitor-based therapy had a beneficial effect on the cerebral circulation by improving CPR in patients with previous minor stroke.
Hatazawa
Jun
J
Department of Radiology, Research Institute of Brain and Blood Vessels, Akita, Japan. hatazawa@tracer.med.osaka-u.ac.jp
Shimosegawa
Eku
E
Osaki
Yasuhiro
Y
Ibaraki
Masanobu
M
Oku
Naohiko
N
Hasegawa
Shinji
S
Nagata
Ken
K
Hirata
Yutaka
Y
Miura
Yuko
Y
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D015897:Comorbidity; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000000981:diagnostic imaging / Q000503:physiopathology; D016857:Hypocapnia / Q000000981:diagnostic imaging / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010313:Partial Pressure; D020913:Perindopril / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D016037:Single-Blind Method; D014661:Vasoconstriction; D014664:Vasodilation
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002245:Carbon Dioxide; D020913:Perindopril