Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension

Oberdan Parodi, Danilo Neglia, Carlo Palombo, Gianmario Sambuceti, Assuero Giorgetti, Claudio Marabotti, Michela Gallopin, Ignazio Simonetti, Antonio L'Abbate

Research output: Contribution to journalArticle

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Abstract

Background: The comparative effects of calcium channel blockers and ACE inhibitors on myocardial blood flow (MBF) in hypertensive patients after long-term treatment are still unknown. Methods and Results: Twenty hypertensive subjects with normal coronary arteries were randomly assigned to verapamil 240 to 480 mg/d or enalapril 10 to 40 mg/d. MBF was quantified at rest, during pacing tachycardia, and after dipyridamole by positron emission tomography and 13N-ammonia before and 6 months after treatment after i week of pharmacological washout. In both groups, blood pressure and heart rate during flow measurements were not different before and after therapy. Before treatment, mean MBF at rest, during pacing tachycardia, and after dipyridamole infusion was similar in the two groups; however, pacing and dipyridamole flows were significantly lower than those obtained in a control group of normotensive subjects. After treatment, in the enalapril-treated patients, MBF did not change in the three study conditions. In the verapamil- treated patients, MBF did not change at rest and significantly increased during pacing and after dipyridamole. The inhomogeneity of regional MBF distribution, evaluated from the coeffecient of variation, decreased at rest after both treatments and, in the enalapril group, also during pacing. No relation was found between changes in MBF and changes in left ventricular mass. Conclusions: In arterial hypertension, MBF during pacing tachycardia and after dipyridamole is impaired. Successful therapy with verapamil increases MBF response to these stimuli, independent of changes in perfusion pressure and left ventricular mass. These results suggest that verapamil directly improves coronary microcirculatory function in hypertension. Enalapril does not significantly change MBF but reduces the inhomogeneity of regional flow distribution.

Original languageEnglish
Pages (from-to)864-873
Number of pages10
JournalCirculation
Volume96
Issue number3
Publication statusPublished - Aug 5 1997

Fingerprint

Enalapril
Verapamil
Hypertension
Dipyridamole
Tachycardia
Therapeutics
Regional Blood Flow
Calcium Channel Blockers
Ventricular Pressure
Ammonia
Angiotensin-Converting Enzyme Inhibitors
Positron-Emission Tomography
Coronary Vessels
Perfusion
Heart Rate
Pharmacology
Blood Pressure
Control Groups

Keywords

  • Calcium channels
  • Hypertension
  • Microcirculation
  • Tomography

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Parodi, O., Neglia, D., Palombo, C., Sambuceti, G., Giorgetti, A., Marabotti, C., ... L'Abbate, A. (1997). Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension. Circulation, 96(3), 864-873.

Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension. / Parodi, Oberdan; Neglia, Danilo; Palombo, Carlo; Sambuceti, Gianmario; Giorgetti, Assuero; Marabotti, Claudio; Gallopin, Michela; Simonetti, Ignazio; L'Abbate, Antonio.

In: Circulation, Vol. 96, No. 3, 05.08.1997, p. 864-873.

Research output: Contribution to journalArticle

Parodi, O, Neglia, D, Palombo, C, Sambuceti, G, Giorgetti, A, Marabotti, C, Gallopin, M, Simonetti, I & L'Abbate, A 1997, 'Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension', Circulation, vol. 96, no. 3, pp. 864-873.
Parodi O, Neglia D, Palombo C, Sambuceti G, Giorgetti A, Marabotti C et al. Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension. Circulation. 1997 Aug 5;96(3):864-873.
Parodi, Oberdan ; Neglia, Danilo ; Palombo, Carlo ; Sambuceti, Gianmario ; Giorgetti, Assuero ; Marabotti, Claudio ; Gallopin, Michela ; Simonetti, Ignazio ; L'Abbate, Antonio. / Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension. In: Circulation. 1997 ; Vol. 96, No. 3. pp. 864-873.
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AU - Neglia, Danilo

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AU - Giorgetti, Assuero

AU - Marabotti, Claudio

AU - Gallopin, Michela

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N2 - Background: The comparative effects of calcium channel blockers and ACE inhibitors on myocardial blood flow (MBF) in hypertensive patients after long-term treatment are still unknown. Methods and Results: Twenty hypertensive subjects with normal coronary arteries were randomly assigned to verapamil 240 to 480 mg/d or enalapril 10 to 40 mg/d. MBF was quantified at rest, during pacing tachycardia, and after dipyridamole by positron emission tomography and 13N-ammonia before and 6 months after treatment after i week of pharmacological washout. In both groups, blood pressure and heart rate during flow measurements were not different before and after therapy. Before treatment, mean MBF at rest, during pacing tachycardia, and after dipyridamole infusion was similar in the two groups; however, pacing and dipyridamole flows were significantly lower than those obtained in a control group of normotensive subjects. After treatment, in the enalapril-treated patients, MBF did not change in the three study conditions. In the verapamil- treated patients, MBF did not change at rest and significantly increased during pacing and after dipyridamole. The inhomogeneity of regional MBF distribution, evaluated from the coeffecient of variation, decreased at rest after both treatments and, in the enalapril group, also during pacing. No relation was found between changes in MBF and changes in left ventricular mass. Conclusions: In arterial hypertension, MBF during pacing tachycardia and after dipyridamole is impaired. Successful therapy with verapamil increases MBF response to these stimuli, independent of changes in perfusion pressure and left ventricular mass. These results suggest that verapamil directly improves coronary microcirculatory function in hypertension. Enalapril does not significantly change MBF but reduces the inhomogeneity of regional flow distribution.

AB - Background: The comparative effects of calcium channel blockers and ACE inhibitors on myocardial blood flow (MBF) in hypertensive patients after long-term treatment are still unknown. Methods and Results: Twenty hypertensive subjects with normal coronary arteries were randomly assigned to verapamil 240 to 480 mg/d or enalapril 10 to 40 mg/d. MBF was quantified at rest, during pacing tachycardia, and after dipyridamole by positron emission tomography and 13N-ammonia before and 6 months after treatment after i week of pharmacological washout. In both groups, blood pressure and heart rate during flow measurements were not different before and after therapy. Before treatment, mean MBF at rest, during pacing tachycardia, and after dipyridamole infusion was similar in the two groups; however, pacing and dipyridamole flows were significantly lower than those obtained in a control group of normotensive subjects. After treatment, in the enalapril-treated patients, MBF did not change in the three study conditions. In the verapamil- treated patients, MBF did not change at rest and significantly increased during pacing and after dipyridamole. The inhomogeneity of regional MBF distribution, evaluated from the coeffecient of variation, decreased at rest after both treatments and, in the enalapril group, also during pacing. No relation was found between changes in MBF and changes in left ventricular mass. Conclusions: In arterial hypertension, MBF during pacing tachycardia and after dipyridamole is impaired. Successful therapy with verapamil increases MBF response to these stimuli, independent of changes in perfusion pressure and left ventricular mass. These results suggest that verapamil directly improves coronary microcirculatory function in hypertension. Enalapril does not significantly change MBF but reduces the inhomogeneity of regional flow distribution.

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