REMODELING OF MYOCARDIUM AND ARTERIES BY CHRONIC ANGIOTENSIN-CONVERTING ENZYME-INHIBITION IN HYPERTENSIVE PATIENTS

Aim: To investigate changes in left ventricular hypertrophy and diasto lic function in hypertensive patients treated with an angiotensin conv erting enzyme (ACE) inhibitor. Methods: Structural and functional chan ges in the heart and iliac artery were studied by echocardiography and intraluminal ultrasound in 15 hypertensive patients following 6 month s of treatment with the ACE inhibitor quinapril at 10-40 mg/day. Resul ts: Systolic/diastolic blood pressure was reduced from 156/100 mmHg to 128/82 mmHg within 2 months and remained stable during the next 4 mon ths of the study. The left ventricular mass index was significantly re duced from 174 +/- 86 to 161 +/- 75 g/m(2) (-7.4%, P<0.05). The reduct ion in left ventricular hypertrophy was associated with a trend toward s an improvement in diastolic function, but left ventricular systolic function did not change. There was a 3.9% increase in iliac lumen area and a significant decrease of 10.7% (P<0.05) in the ratio between the intimal-medial and lumen area, which represents a decrease in wall th ickness. A key result was a statistically significant decrease in puls e-wave velocity, from 13.7 +/- 2.6 to 12.1 +/- 2.0 m/s, and in the mod ulus of elasticity, from 20.5 +/- 7.2 to 15.8 +/- 5.6 x 10(4) N/m(2) ( P<0.05). Conclusion: The present study demonstrates that 6 months of t reatment with an ACE inhibitor induced a significant regression in lef t ventricular hypertrophy and a reduction in wall thickness. In additi on, the results indicate that chronic ACE inhibition can decrease the stiffness of large elastic arteries independently of a reduction in bl ood pressure.