REGRESSION OF MEDIA-TO-LUMEN RATIO OF HUMAN SUBCUTANEOUS ARTERIES ANDLEFT-VENTRICULAR HYPERTROPHY DURING TREATMENT WITH AN ANGIOTENSIN-CONVERTING ENZYME INHIBITOR-BASED REGIMEN IN HYPERTENSIVE PATIENTS

A total of 25 patients with newly diagnosed or poorly controlled essen tial hypertension were randomly selected from a larger group referred to hospital. Treatment was initiated with perindopril (4-8 mg orally). If normotension was not achieved, isradipine (5-10 mg orally) was add ed and, if necessary, hydralazine was added. Before treatment and at t he end of a 9-month period of normotension (diastolic blood pressure l ess than or equal to 90 mm Hg), 24-hour blood pressure and echocardiog raphic measurements were performed and resistance artery structure was determined. A total of 20 age- and sex-matched normotensives were use d as controls. During antihypertensive treatment, mean blood pressure was reduced from 128 +/- 11 to 103 +/- 6 mm Hg. Left ventricular mass was reduced from 300 +/- 76 to 198 +/- 54 g. The media:lumen ratio of the resistance arteries decreased from 9.8 +/- 2.6% to 7.8 +/- 1.9%; c ontrol subjects exhibited a media:lumen ratio of the same magnitude (7 .9 +/- 2.0%). Results indicate that a perindopril-based regimen is ext remely efficient in normalizing resistance artery and cardiac ventricu lar structures within one year of treatment. The impact of these findi ngs on the excess cardiovascular morbidity and mortality in arterial h ypertension still remains to be demonstrated.