title: Effect of antihypertensive treatment on microvascular structure, central blood pressure and oxidative stress in patients with mild essential hypertension.
abstract: BACKGROUND
  It has been previously demonstrated that dihydropyridine calcium channel blockers may possess antioxidant properties and might improve vascular structure. Combination treatment with an angiotensin-converting enzyme inhibitor may have additional advantages, compared with a thiazide diuretic, in this regard. The aim of the present study was, therefore, to investigate the effects of a short-term treatment with lercanidipine, and to compare two combination treatments: lercanidipine + enalapril vs. lercanidipine + hydrochlorothiazide on structural alterations in retinal arterioles, on skin capillary density and on large artery distensibility.
  
  
  METHODS
  Twenty essential hypertensive patients were included in the study and treated for 4 weeks with lercanidipine 20 mg per day orally. Then they were treated for 6 months with lercanidipine + enalapril (n=10) or lercanidipine + hydrochlorothiazide (n=10) combinations. Investigations were performed in basal condition, after appropriate washout of previous treatments, after 4 weeks of lercanidipine monotherapy treatment, and at the end of the combination treatment. Non-invasive measurements of wall-to-lumen ratio (W/L) and other morphological parameters of retinal arterioles using scanning laser Doppler flowmetry were performed (Heidelberg Retina Flowmeter, Heidelberg Engineering). Capillary density was evaluated by capillaroscopy, whereas pulse wave velocity and central blood pressure were assessed by the Sphygmo-Cor device (AtCor Medical West Ryde, Australia).
  
  
  RESULTS
  A significant improvement of W/L and of other indices of retinal artery structure was observed after treatment with lercanidipine alone, with a further improvement after treatment with lercanidipine + enalapril, whereas after treatment with lercanidipine + hydrochlorothiazide the improvement was no longer observed. A similar behaviour was observed for central SBP and DBP. Capillary density was increased only after treatment with lercanidipine + enalapril.
  
  
  CONCLUSIONS
  Lercanidipine both in monotherapy and in combination with enalapril, was able to improve microvascular structure and to decrease central blood pressure, being thus a useful approach for both reducing blood pressure and improving vascular alterations in hypertension.
authors.affiliation: aClinica Medica, Department of Clinical and Experimental Sciences bChair of Ophthalmology cChair of Clinical Biochemistry, University of Brescia, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: De Ciuceis
authors.forename: Massimo
authors.initials: M
authors.lastname: Salvetti
authors.forename: Claudia
authors.initials: C
authors.lastname: Rossini
authors.forename: Maria Lorenza
authors.initials: ML
authors.lastname: Muiesan
authors.forename: Anna
authors.initials: A
authors.lastname: Paini
authors.forename: Sarah
authors.initials: S
authors.lastname: Duse
authors.forename: Elisa
authors.initials: E
authors.lastname: La Boria
authors.forename: Francesco
authors.initials: F
authors.lastname: Semeraro
authors.forename: Anna
authors.initials: A
authors.lastname: Cancarini
authors.forename: Claudia Agabiti
authors.initials: CA
authors.lastname: Rosei
authors.forename: Annamaria
authors.initials: A
authors.lastname: Sarkar
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Ruggeri
authors.forename: Luigi
authors.initials: L
authors.lastname: Caimi
authors.forename: Doris
authors.initials: D
authors.lastname: Ricotta
authors.forename: Damiano
authors.initials: D
authors.lastname: Rizzoni
authors.forename: Enrico Agabiti
authors.initials: EA
authors.lastname: Rosei
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001160:Arterioles / Q000000981:diagnostic imaging / Q000187:drug effects; D001794:Blood Pressure / Q000502:physiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D004095:Dihydropyridines / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage; D000075222:Essential Hypertension; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D006973:Hypertension / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply / Q000187:drug effects; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D014463:Ultrasonography
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D004232:Diuretics; D006852:Hydrochlorothiazide; D004656:Enalapril; C060343:lercanidipine