C. Giannattasio et al., ANGIOTENSIN-CONVERTING ENZYME-INHIBITION AND RADIAL ARTERY COMPLIANCEIN PATIENTS WITH CONGESTIVE-HEART-FAILURE, Hypertension, 26(3), 1995, pp. 491-496
Congestive heart failure is characterized by a clear-cut impairment of
arterial compliance of medium-sized arteries, but whether this altera
tion is irreversible or can be favorably affected by cardiovascular dr
ugs currently used in congestive heart failure treatment is unknown. W
e studied 9 congestive heart failure patients (New York Heart Associat
ion class II; age, [mean+/-SEM] 60.7+/-3.3 years) receiving diuretic a
nd digitalis treatment in whom arterial compliance was assessed at the
level of the radial artery by an echotracking device capable of measu
ring the arterial diameter along the entire cardiac cycle. Beat-to-bea
t arterial blood pressure was concomitantly measured by a Finapres dev
ice that allowed diameter-pressure curves and compliance-pressure curv
es (Langewouters' formula) to be calculated for the entire systolic-di
astolic blood pressure range. Arterial compliance was expressed as the
area under the compliance-pressure curve normalized for pulse pressur
e (compliance index). Data were collected before and after 4 and 8 wee
ks of oral administration of benazepril (10 mg/day). Ten healthy subje
cts were studied before and after an observational period of 4 weeks (
5 subjects) or 8 weeks (5 subjects), and 9 age-matched mildly essentia
l hypertensive subjects studied before and after 4 to 12 weeks of bena
zepril administration served as control subjects. In congestive heart
failure patients, baseline compliance index was significantly less tha
n in normotensive and hypertensive subjects. However, the compliance i
ndex showed a marked increase after 4 weeks of benazepril administrati
on (+95.7+/-24.9%, P<.05); the increase was also marked after 8 weeks
of angiotensin-converting enzyme inhibitor treatment (+77.7+/-4.2%, P<
.05). At this time the compliance values of the congestive heart failu
re patients were not different from those of the healthy and hypertens
ive groups, in which the Observational period and angiotensin-converti
ng enzyme inhibitor administration, respectively, had brought no chang
e in compliance. Similar results were observed when compliance index w
as calculated for the blood pressure range shared by the three groups
(isobaric compliance). These data provide the first evidence that the
impairment of arterial compliance occurring in congestive heart failur
e can be favorably affected by the addition of an angiotensin-converti
ng enzyme inhibitor to the treatment regimen. This has favorable impli
cations for the cardiovascular functions adversely affected by a reduc
ed arterial compliance leg, cardiac work and oxygen consumption, coron
ary perfusion, and arterial baroreflex).