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 journalArticlepeer-review


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
Issue number2
Publication statusPublished - Feb 2011


  • 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


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