Background: Patients (pts) with arterial hypertension (Ht) and left ventricular hypertrophy (LVH) are at high risk of developing cardiac events. They often complain of angina and have ST segment depression during stress suggesting myocardial ischemia despite angiographically normal coronary arteries in most cases. This is due to coronary microvascular dysfunction caused by remodelling of intramural coronary arterioles which can be assessed non-invasively by measuring myocardial blood flow (MBF) using positron emission tomography (PET). Aim of this study was to ascertain whether pharmacologic treatment with a fixed combination of perindopril+indapamide can improve coronary microvascular dysfunction in pts with Ht and LVH. Methods: Fifteen pts (mean age 60±6 years, 5 females) with arterial Ht (≥140/90 and <180/110 mmHg) complicated by LVH, with no evidence of other organ damage or concomitant disease and in therapy wash-out (1 to 4 weeks depending on preceding treatment) were studied. At baseline LV mass (LVM) was measured by cardiovascular magnetic resonance (CMR) and absolute resting and hyperemic (dipyridamole 0.56 mg/kg) MBF was measured by PET with nitrogen-13 labelled ammonia. CMR and PET scans were repeated after 6 months of therapy. The initial dosage of the combination was 2/0.625 mg (perindopril and indapamide, respectively) which was titrated, if needed, up to 8/2.5 mg during follow up. Results: SBP decreased from 160±11 (mean±SD) to 140±15 mmHg (p<0.01), DBP from 97±6 to 83±7 mmHg (p<0.0001) and LVM from 159±39 to 146±34 g (p<0.05). Resting MBF increased from 0.67±0.13 to 0.91±0.38 (M6) ml/min/g (p<0.001) and maximum MBF during dipyridamole from 1.45±0.31 to 2.03±1.14 ml/min/g (p=0.06). Conclusions: Six month treatment with perindopril+indapamide in pts with Ht and LVH causes a significant decrease in SBP, DBP and LVM which is accompanied by an increase in resting and hyperemic MBF. This suggests that coronary microvascular dysfunction can be reversed by treatment with these drugs and might contribute to the prevention of ischemic heart disease in these pts.
Coronary microvascular dysfunction in hypertensive patients with left ventricular hypertrophy can be reversed by treatment with a fixed combination of perindropril and indapamide
FOMMEI, ENZA;
2008-01-01
Abstract
Background: Patients (pts) with arterial hypertension (Ht) and left ventricular hypertrophy (LVH) are at high risk of developing cardiac events. They often complain of angina and have ST segment depression during stress suggesting myocardial ischemia despite angiographically normal coronary arteries in most cases. This is due to coronary microvascular dysfunction caused by remodelling of intramural coronary arterioles which can be assessed non-invasively by measuring myocardial blood flow (MBF) using positron emission tomography (PET). Aim of this study was to ascertain whether pharmacologic treatment with a fixed combination of perindopril+indapamide can improve coronary microvascular dysfunction in pts with Ht and LVH. Methods: Fifteen pts (mean age 60±6 years, 5 females) with arterial Ht (≥140/90 and <180/110 mmHg) complicated by LVH, with no evidence of other organ damage or concomitant disease and in therapy wash-out (1 to 4 weeks depending on preceding treatment) were studied. At baseline LV mass (LVM) was measured by cardiovascular magnetic resonance (CMR) and absolute resting and hyperemic (dipyridamole 0.56 mg/kg) MBF was measured by PET with nitrogen-13 labelled ammonia. CMR and PET scans were repeated after 6 months of therapy. The initial dosage of the combination was 2/0.625 mg (perindopril and indapamide, respectively) which was titrated, if needed, up to 8/2.5 mg during follow up. Results: SBP decreased from 160±11 (mean±SD) to 140±15 mmHg (p<0.01), DBP from 97±6 to 83±7 mmHg (p<0.0001) and LVM from 159±39 to 146±34 g (p<0.05). Resting MBF increased from 0.67±0.13 to 0.91±0.38 (M6) ml/min/g (p<0.001) and maximum MBF during dipyridamole from 1.45±0.31 to 2.03±1.14 ml/min/g (p=0.06). Conclusions: Six month treatment with perindopril+indapamide in pts with Ht and LVH causes a significant decrease in SBP, DBP and LVM which is accompanied by an increase in resting and hyperemic MBF. This suggests that coronary microvascular dysfunction can be reversed by treatment with these drugs and might contribute to the prevention of ischemic heart disease in these pts.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
