title: Long-term treatment with ramipril favourably modifies the haemostatic response to acute submaximal exercise in hypertensives.
abstract: BACKGROUND
  Hypertension links to a prothrombotic state driven by endothelial dysfunction, reduced fibrinolytic potential and platelet hyperactivity. We hypothesized that ramipril treatment would favourably modify the haemostatic response to a submaximal aerobic exercise session in hypertensives.
  
  
  METHODS
  Twenty-four hypertensive patients underwent a submaximal exercise test before and after 13±2 months of treatment with ramipril ± hydrochlorothiazide. Hypercoagulability (prothrombin fragments [PF1+2], thrombin- antithrombin complex [TAT] and D-dimers [Dd]), fibrinolytic activity (plasmin-a2-antiplasmin complex [PAP]), endothelial function (von Willebrand factor [vWf] and soluble thrombomodulin [sTM]), and platelet function (soluble P-selectin [sPsel]) were measured before, at peak and one hour after exercise.
  
  
  RESULTS
  Antihypertensive treatment resulted in an increase of PAP, vWf and sTM. During the first exercise, PF1+2 were mildly increased at peak exercise (p<0.05), while D-dimers, PAP and vWf varied significantly throughout the exercise (p<0.001). During the second exercise session, PF1+2 were decreased post-exercise (p<0.05), PAP was increased at peak and post-exercise (p<0.001) and vWf was increased at peak (p<0.05) and post-exercise (p<0.001).
  
  
  CONCLUSIONS
  The haemostatic response to exercise in hypertensives after approximately one year of ramipril treatment is characterized by the attenuated activation of coagulation, enhanced fibrinolysis and endothelial activation.
authors.affiliation: 1Haematology Laboratory, Evangelismos Hospital, Athens, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Galea
authors.forename: Helen
authors.initials: H
authors.lastname: Triantafyllidi
authors.forename: Theodoros
authors.initials: T
authors.lastname: Theodoridis
authors.forename: Matina
authors.initials: M
authors.lastname: Koutroumbi
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Christopoulou-Cokkinou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kremastinos
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
mesh_terms: D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D003710:Demography; D004730:Endothelium, Vascular / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D015444:Exercise; D005337:Fibrin / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000494:pharmacology / Q000627:therapeutic use*; D013917:Thrombin / Q000378:metabolism; D013997:Time Factors
chemical_list: D005337:Fibrin; D013917:Thrombin; D017257:Ramipril