[Effect of fosinopril on progression of the asymptomatic carotid atherosclerosis and left ventricular hypertrophy in hypertensive patients].
BACKGROUND
The cardiovascular changes (vascular structure changes, hypertrophy of the left ventricle) contribute to both the increased cardiovascular morbidity and the mortality of essential hypertension. Therefore, modern treatment strategies should not only target blood pressure (BP) reduction but also normalize cardiovascular structure and function.


OBJECTIVE
Aim of the study was to determine the effect of the ACE inhibitor Fosinopril on the intima-media thickness of the common carotid artery and on the left ventricle mass after 9-month treatment of hypertensive patients.


METHODS
The study included 40 patients with the arterial hypertension and the left ventricle hypertrophy verified by echocardiography. The patients were randomized on A) ACE-inhibitor--Fosinopril and B) without ACE inhibitor--atenolol, and they were followed up 9 months. The groups were not different by age, sex, and metabolic status. Color Duplex ultrasonography of the carotid arteries was performed by Acuson Sequia C236 with high-frequency linear probe of 8 MHz. The intima-media thickness of the common carotids on the left and the right was measured in diastole at 1.5 cm from the highest point of bifurcation under maximal magnification. Using the same device, the left ventricle mass and other parameters of the left ventricle were determined in M-mode and by means of 2D image.


RESULTS
After 9 months, BP in both groups was reduced in similar range (group A: systolic BP from 158 to 137 mmHg, and diastolic BP from 94 to 85 mmHg, and group B: systolic BP from 164 to 137 mmHg, and diastolic BP from 87 to 84 mmHg). The thickness of the intimomedial complex in patients using Fosinopril was decreased by 0.0278 +/- 0.03 mm, while in the group of patients that did not use the ACE-inhibitor, it was increased by 0.078 +/- 0.13 mm. The left ventricle mass in patients using Fosinopril was decreased by 5 grams (312 +/- 72 g vs. 307 +/- 77 g), while in group B patients, it was increased by 15 grams (323 +/- 79 g vs. 328 +/- 58 g. Diastolic function expressed through relation E/A was improved minimally in the group A, while it worsened by 0.1 in the group B. After 9 months, serious cardiovascular events were recorded (one infarction of myocardium and one hospitalization due to the unstable angina pectoris) in two patients of the group A, while four patients of the group B had serious CV events (1 cerebrovascular stroke and 3 hospitalizations due to unstable angina pectoris).


CONCLUSIONS
The results of our study showed that the application of Fosinopril in patients with the arterial hypertension and the left ventricle hypertrophy could efficiently block further progression of the intima-medial thickness of the common carotid artery, reduce the left ventricle mass, and improve diastolic function of the left ventricle.
Tasić
Ivan S
IS
Mijalković
Dragan
D
Djordjević
Dragan
D
Lović
Branko
B
Janković
Dimitrije
D
Miladinović-Tasić
Natasa
N
Lović
Milan
M
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D017328:Fosinopril / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged
D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D001262:Atenolol; D017328:Fosinopril