TRANDOLAPRIL IN PATIENTS WITH ESSENTIAL-HYPERTENSION - EFFECTS ON VASCULAR AND CARDIAC STRUCTURAL-CHANGES

Elevated arterial pressure levels increase the hemodynamic load on hea rt and vessels, thus leading to functional and structural abnormalitie s. Because cardiac and vascular changes increase the risk of cardiovas cular disease, their reversal is an important target of antihypertensi ve therapy, even though the prognostic value of this regression has no t been fully established. In patients with untreated mild-to-moderate essential hypertension and left ventricular hypertrophy, trandolapril, a new angiotensin-converting enzyme inhibitor, reduces blood pressure by decreasing total peripheral resistance and improves both systolic and diastolic ventricular function. The latter effect is not only func tional in nature because, after long-term antihypertensive treatment, the improvement in diastolic ventricular function is detectable also a fter 1-month withdrawal of trandolapril. The concurrent reversal of le ft ventricular hypertrophy may contribute to the improved left ventric ular diastolic function. However, plethysmographic studies suggest tha t long-term antihypertensive treatment with trandolapril is also able to reverse structural vascular changes in the forearm vascular bed, be cause after 1-month washout forearm peripheral resistance also is lowe r than in control conditions. Finally, in hypertensive patients, trand olapril induces significant increases in brachial artery compliance an d diameter that persist after 1 month of withdrawal from treatment. Th e latter observation suggests that trandolapril also is able to revers e the structural changes of the large artery wall. The uniform regress ion of the hypertension-induced structural changes in the heart and in the large as well as the small arteries induced by trandolapril sugge sts that this drug exerts a significant protective effect against the risk of cardiovascular disease associated with systemic essential hype rtension.