Effect of Treatment With Candesartan or Enalapril on Subcutaneous Small Artery Structure in Hypertensive Patients With Noninsulin-Dependent Diabetes Mellitus
- 1 April 2005
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Hypertension
- Vol. 45 (4), 659-665
- https://doi.org/10.1161/01.HYP.0000153308.91043.97
Abstract
Structural alterations of subcutaneous small resistance arteries are associated with a worse clinical prognosis in hypertension and noninsulin-dependent diabetes mellitus (NIDDM). However, no data are presently available about the effects of antihypertensive therapy on vascular structure in hypertensive patients with NIDDM. Therefore, we have investigated the effect of an angiotensin-converting enzyme inhibitor, enalapril, and a highly selective angiotensin receptor blocker, candesartan cilexetil, on indices of subcutaneous small resistance artery structure in 15 patients with mild hypertension and NIDDM. Eight patients were treated with candesartan (8 to 16 mg per day) and 7 with enalapril (10 to 20 mg per day) for 1 year. Each patient underwent a biopsy of the subcutaneous fat from the gluteal region at baseline and after 1 year of treatment. Small arteries were dissected and mounted on a micromyograph and the media-to-internal lumen ratio was evaluated; moreover, endothelium-dependent vasodilation to acetylcholine was assessed. A similar blood pressure-lowering effect and a similar reduction of the media-to-lumen ratio of small arteries was observed with the 2 drugs. Vascular collagen content was reduced and metalloproteinase-9 was increased by candesartan, but not by enalapril. Changes of circulating indices of collagen turnover and circulating matrix metalloproteinase paralleled those of vascular collagen. The 2 drugs equally improved endothelial function. In conclusion, antihypertensive treatment with drugs that inhibit the renin-angiotensin-aldosterone system activity is able to correct, at least in part, alterations in small resistance artery structure in hypertensive patients with NIDDM. Candesartan may be more effective than enalapril in reducing collagen content in the vasculature.Keywords
This publication has 20 references indexed in Scilit:
- Persistent Remodeling of Resistance Arteries in Type 2 Diabetic Patients on Antihypertensive TreatmentHypertension, 2004
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and Evidence From New Hypertension TrialsHypertension, 2004
- Looking back, looking forwardJournal Of Hypertension, 2004
- Prognostic Significance of Small-Artery Structure in HypertensionCirculation, 2003
- Relationships between coronary flow vasodilator capacity and small artery remodelling in hypertensive patients.Journal Of Hypertension, 2003
- Vascular Structural and Functional Changes in Type 2 Diabetes MellitusCirculation, 2002
- Cellular Mechanisms of Diabetic Vascular HypertrophyMicrovascular Research, 1999
- Effects of long-term antihypertensive treatment with lisinopril on resistance arteries in hypertensive patients with left ventricular hypertrophyJournal Of Hypertension, 1997
- Effects of a beta-blocker or a converting enzyme inhibitor on resistance arteries in essential hypertension.Hypertension, 1994
- Small artery structure in hypertension. Dual processes of remodeling and growth.Hypertension, 1993