Effects of blood pressure control with perindopril/indapamide on the microcirculation in hypertensive patients.
BACKGROUND
Microvascular rarefaction and endothelium dysfunction are hallmarks of hypertension. We assessed whether antihypertensive treatments affect the microcirculation and whether the fixed-dose combination perindopril/indapamide (per/ind) modifies the microcirculation of hypertensive patients independently of blood pressure reduction.


METHODS
One hundred ninety-three consecutive patients were enrolled into one of four groups depending on their blood pressure and existing treatment: (i) controlled hypertensive patients treated with per/ind (controlled-per/ind), (ii) controlled hypertensive patients treated with agents other than angiotensin-converting enzyme (ACE) inhibitors or diuretics (controlled-other), (iii) uncontrolled hypertensive patients treated with agents other than ACE inhibitors or diuretics (uncontrolled-other), (iv) untreated normotensive subjects. Macro- and microcirculation parameters were evaluated once in every patient. We used intravital video microscopy to measure dermal capillary density in the dorsum of the fingers. Microvascular endothelial function was assessed by measuring the perfusion increases after pilocarpine iontophoresis and central hemodynamic parameters by tonometry.


RESULTS
Capillary density was significantly higher in controlled-per/ind patients (99 ± 12 capillaries/mm(2)) than in all other groups (P < 0.05). Controlled-per/ind patients had a significantly greater endothelial response to pilocarpine than patients from all other groups (P < 0.05). Central hemodynamic parameters were similarly improved in both controlled groups compared with the uncontrolled-other group (P < 0.05).


CONCLUSIONS
Thus, hypertensive patients with blood pressure controlled with the combination per/ind had normalized capillary density and endothelial function, whereas other antihypertensive treatments, excluding ACE inhibitors or diuretics, had less effect despite similar blood pressure control.
Department of Non-Invasive Investigations, PARCC Inserm U, Inserm U, Lariboisière Hospital, AP-HP, University Paris Diderot, France.
Haytem
H
Debbabi
Philippe
P
Bonnin
Bernard I
BI
Levy
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002196:Capillaries / Q000187:drug effects / Q000502:physiology; D018592:Cross-Over Studies; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000627:therapeutic use*; D004338:Drug Combinations; D004730:Endothelium, Vascular / Q000187:drug effects; D005260:Female; D005385:Fingers / Q000098:blood supply; D005602:France; D058006:General Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D007190:Indapamide / Q000627:therapeutic use*; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use*; D014664:Vasodilation / Q000187:drug effects
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D004338:Drug Combinations; D007190:Indapamide; D020913:Perindopril