Remodeling of myocardium and arteries by chronic angiotensin converting enzyme inhibition in hypertensive patients

Abstract

To investigate changes in left ventricular hypertrophy and diastolic function in hypertensive patients treated with an angiotensin converting enzyme (ACE) inhibitor. Structural and functional changes in the heart and iliac artery were studied by echocardiography and intraluminal ultrasound in 15 hypertensive patients following 6 months of treatment with the ACE inhibitor quinapril at 10-40 mg/day. Systolic/diastolic blood pressure was reduced from 156/100 mmHg to 128/82 mmHg within 2 months and remained stable during the next 4 months of the study. The left ventricular mass index was significantly reduced from 174 +/- 86 to 161 +/- 75 g/m2 (-7.4%, P < 0.05). The reduction in left ventricular hypertrophy was associated with a trend towards an improvement in diastolic function, but left ventricular systolic function did not change. There was a 3.9% increase in iliac lumen area and a significant decrease of 10.7% (P < 0.05) in the ratio between the intimal-medial and lumen area, which represents a decrease in wall thickness. A key result was a statistically significant decrease in pulse-wave velocity, from 13.7 +/- 2.6 to 12.1 +/- 2.0 m/s, and in the modulus of elasticity, from 20.5 +/- 7.2 to 15.8 +/- 5.6 x 10(4) N/m2 (P < 0.05). The present study demonstrates that 6 months of treatment with an ACE inhibitor induced a significant regression in left ventricular hypertrophy and a reduction in wall thickness. In addition, the results indicate that chronic ACE inhibition can decrease the stiffness of large elastic arteries independently of a reduction in blood pressure.