Perindopril and indapamide reverse coronary microvascular remodelling and improve flow in arterial hypertension

Danilo Neglia, Enza Fommei, Anabel Varela-Carver, Massimiliano Mancini, Sergio Ghione, Massimo Lombardi, Patrizia Pisani, Howard Parker, Giulia D'Amati, Luigi Donato, Paolo G. Camici

Research output: Contribution to journalArticle

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Abstract

Objectives: Patients and animal models of arterial hypertension are characterized by structural and functional abnormalities of the coronary microcirculation. Using a translational approach, we ascertained whether antihypertensive treatment can reverse microvascular remodelling and improve myocardial perfusion. Methods: In 20 hypertensive patients with left ventricular hypertrophy, blood pressure, left ventricular mass index and myocardial blood flow were measured at baseline and after 6 months of treatment with perindopril + indapamide. In spontaneously hypertensive rats, blood pressure, coronary flow and histomorphometry of intramural coronary arterioles were measured after 8 weeks of treatment with placebo or perindopril + indapamide. Results: In patients, treatment decreased blood pressure (161 ± 10/96 ± 5 to 136 ± 12/81 ± 6 mmHg; P <0.0001) and left ventricular mass index (93 ± 16 to 85 ± 17 g/m 2; P <0.01) while increasing baseline (0.69 ± 0.13 to 0.88 ± 0.36 ml/min per g; P <0.05) and hyperaemic myocardial blood flow (1.42 ± 0.32 to 1.94 ± 0.99 ml/min per g; P <0.05). In rats treated with perindopril + indapamide (n = 11), blood pressure was 93 ± 18/55 ± 18 mmHg compared to 215 ± 18/161 ± 17 mmHg in placebo (n = 6; P <0.001), baseline flow was unchanged whilst hyperaemic coronary flow was 19.89 ± 3.50 vs. 12.15 ± 0.99 ml/min per g, respectively (P <0.01). The medial area of intramural arterioles was 1613 ± 409 with perindopril + indapamide and 8118 ± 901 μm with placebo (P <0.001). Conclusion: In patients with arterial hypertension and left ventricular hypertrophy, perindopril + indapamide reduced blood pressure and left ventricular mass index and improved resting and hyperaemic myocardial blood flow. Data in rats provide evidence that the improvement in coronary flow observed after treatment is due to reverse remodelling of intramural coronary arterioles and improved microvascular function.

Original languageEnglish
Pages (from-to)364-372
Number of pages9
JournalJournal of Hypertension
Volume29
Issue number2
DOIs
Publication statusPublished - Feb 2011

Fingerprint

Indapamide
Perindopril
Blood Pressure
Hypertension
Arterioles
Placebos
Left Ventricular Hypertrophy
Therapeutics
Inbred SHR Rats
Microcirculation
Antihypertensive Agents
Animal Models
Perfusion

Keywords

  • antihypertensive drugs
  • arterial hypertension
  • cardiac imaging
  • coronary microvascular dysfunction
  • myocardial blood flow
  • spontaneously hypertensive rat

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Perindopril and indapamide reverse coronary microvascular remodelling and improve flow in arterial hypertension. / Neglia, Danilo; Fommei, Enza; Varela-Carver, Anabel; Mancini, Massimiliano; Ghione, Sergio; Lombardi, Massimo; Pisani, Patrizia; Parker, Howard; D&apos;Amati, Giulia; Donato, Luigi; Camici, Paolo G.

In: Journal of Hypertension, Vol. 29, No. 2, 02.2011, p. 364-372.

Research output: Contribution to journalArticle

Neglia, D, Fommei, E, Varela-Carver, A, Mancini, M, Ghione, S, Lombardi, M, Pisani, P, Parker, H, D&apos;Amati, G, Donato, L & Camici, PG 2011, 'Perindopril and indapamide reverse coronary microvascular remodelling and improve flow in arterial hypertension', Journal of Hypertension, vol. 29, no. 2, pp. 364-372. https://doi.org/10.1097/HJH.0b013e328340a08e
Neglia, Danilo ; Fommei, Enza ; Varela-Carver, Anabel ; Mancini, Massimiliano ; Ghione, Sergio ; Lombardi, Massimo ; Pisani, Patrizia ; Parker, Howard ; D&apos;Amati, Giulia ; Donato, Luigi ; Camici, Paolo G. / Perindopril and indapamide reverse coronary microvascular remodelling and improve flow in arterial hypertension. In: Journal of Hypertension. 2011 ; Vol. 29, No. 2. pp. 364-372.
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abstract = "Objectives: Patients and animal models of arterial hypertension are characterized by structural and functional abnormalities of the coronary microcirculation. Using a translational approach, we ascertained whether antihypertensive treatment can reverse microvascular remodelling and improve myocardial perfusion. Methods: In 20 hypertensive patients with left ventricular hypertrophy, blood pressure, left ventricular mass index and myocardial blood flow were measured at baseline and after 6 months of treatment with perindopril + indapamide. In spontaneously hypertensive rats, blood pressure, coronary flow and histomorphometry of intramural coronary arterioles were measured after 8 weeks of treatment with placebo or perindopril + indapamide. Results: In patients, treatment decreased blood pressure (161 ± 10/96 ± 5 to 136 ± 12/81 ± 6 mmHg; P <0.0001) and left ventricular mass index (93 ± 16 to 85 ± 17 g/m 2; P <0.01) while increasing baseline (0.69 ± 0.13 to 0.88 ± 0.36 ml/min per g; P <0.05) and hyperaemic myocardial blood flow (1.42 ± 0.32 to 1.94 ± 0.99 ml/min per g; P <0.05). In rats treated with perindopril + indapamide (n = 11), blood pressure was 93 ± 18/55 ± 18 mmHg compared to 215 ± 18/161 ± 17 mmHg in placebo (n = 6; P <0.001), baseline flow was unchanged whilst hyperaemic coronary flow was 19.89 ± 3.50 vs. 12.15 ± 0.99 ml/min per g, respectively (P <0.01). The medial area of intramural arterioles was 1613 ± 409 with perindopril + indapamide and 8118 ± 901 μm with placebo (P <0.001). Conclusion: In patients with arterial hypertension and left ventricular hypertrophy, perindopril + indapamide reduced blood pressure and left ventricular mass index and improved resting and hyperaemic myocardial blood flow. Data in rats provide evidence that the improvement in coronary flow observed after treatment is due to reverse remodelling of intramural coronary arterioles and improved microvascular function.",
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AU - Neglia, Danilo

AU - Fommei, Enza

AU - Varela-Carver, Anabel

AU - Mancini, Massimiliano

AU - Ghione, Sergio

AU - Lombardi, Massimo

AU - Pisani, Patrizia

AU - Parker, Howard

AU - D&apos;Amati, Giulia

AU - Donato, Luigi

AU - Camici, Paolo G.

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N2 - Objectives: Patients and animal models of arterial hypertension are characterized by structural and functional abnormalities of the coronary microcirculation. Using a translational approach, we ascertained whether antihypertensive treatment can reverse microvascular remodelling and improve myocardial perfusion. Methods: In 20 hypertensive patients with left ventricular hypertrophy, blood pressure, left ventricular mass index and myocardial blood flow were measured at baseline and after 6 months of treatment with perindopril + indapamide. In spontaneously hypertensive rats, blood pressure, coronary flow and histomorphometry of intramural coronary arterioles were measured after 8 weeks of treatment with placebo or perindopril + indapamide. Results: In patients, treatment decreased blood pressure (161 ± 10/96 ± 5 to 136 ± 12/81 ± 6 mmHg; P <0.0001) and left ventricular mass index (93 ± 16 to 85 ± 17 g/m 2; P <0.01) while increasing baseline (0.69 ± 0.13 to 0.88 ± 0.36 ml/min per g; P <0.05) and hyperaemic myocardial blood flow (1.42 ± 0.32 to 1.94 ± 0.99 ml/min per g; P <0.05). In rats treated with perindopril + indapamide (n = 11), blood pressure was 93 ± 18/55 ± 18 mmHg compared to 215 ± 18/161 ± 17 mmHg in placebo (n = 6; P <0.001), baseline flow was unchanged whilst hyperaemic coronary flow was 19.89 ± 3.50 vs. 12.15 ± 0.99 ml/min per g, respectively (P <0.01). The medial area of intramural arterioles was 1613 ± 409 with perindopril + indapamide and 8118 ± 901 μm with placebo (P <0.001). Conclusion: In patients with arterial hypertension and left ventricular hypertrophy, perindopril + indapamide reduced blood pressure and left ventricular mass index and improved resting and hyperaemic myocardial blood flow. Data in rats provide evidence that the improvement in coronary flow observed after treatment is due to reverse remodelling of intramural coronary arterioles and improved microvascular function.

AB - Objectives: Patients and animal models of arterial hypertension are characterized by structural and functional abnormalities of the coronary microcirculation. Using a translational approach, we ascertained whether antihypertensive treatment can reverse microvascular remodelling and improve myocardial perfusion. Methods: In 20 hypertensive patients with left ventricular hypertrophy, blood pressure, left ventricular mass index and myocardial blood flow were measured at baseline and after 6 months of treatment with perindopril + indapamide. In spontaneously hypertensive rats, blood pressure, coronary flow and histomorphometry of intramural coronary arterioles were measured after 8 weeks of treatment with placebo or perindopril + indapamide. Results: In patients, treatment decreased blood pressure (161 ± 10/96 ± 5 to 136 ± 12/81 ± 6 mmHg; P <0.0001) and left ventricular mass index (93 ± 16 to 85 ± 17 g/m 2; P <0.01) while increasing baseline (0.69 ± 0.13 to 0.88 ± 0.36 ml/min per g; P <0.05) and hyperaemic myocardial blood flow (1.42 ± 0.32 to 1.94 ± 0.99 ml/min per g; P <0.05). In rats treated with perindopril + indapamide (n = 11), blood pressure was 93 ± 18/55 ± 18 mmHg compared to 215 ± 18/161 ± 17 mmHg in placebo (n = 6; P <0.001), baseline flow was unchanged whilst hyperaemic coronary flow was 19.89 ± 3.50 vs. 12.15 ± 0.99 ml/min per g, respectively (P <0.01). The medial area of intramural arterioles was 1613 ± 409 with perindopril + indapamide and 8118 ± 901 μm with placebo (P <0.001). Conclusion: In patients with arterial hypertension and left ventricular hypertrophy, perindopril + indapamide reduced blood pressure and left ventricular mass index and improved resting and hyperaemic myocardial blood flow. Data in rats provide evidence that the improvement in coronary flow observed after treatment is due to reverse remodelling of intramural coronary arterioles and improved microvascular function.

KW - antihypertensive drugs

KW - arterial hypertension

KW - cardiac imaging

KW - coronary microvascular dysfunction

KW - myocardial blood flow

KW - spontaneously hypertensive rat

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