IMPROVEMENT OF ARTERIAL COMPLIANCE BY A C ONVERTING-ENZYME-INHIBITOR IN PATIENTS WITH LOWER-EXTREMITIES ARTERIAL-DISEASE

Objective : To determine whether long-term treatment with cilazapril ( CIL) may improve pulse pressure (PP), arterial compliance and ankle-ar m systolic index (AAI) in patients with lower-extremity arterial disea se (LEAD). Indeed, in both systolic hypertension and LEAD, the increas e in pulse pressure has been attributed to a reduced compliance. Desig n and methods : Thirteen patients (age : 65 +/- 5 yrs ; AAI: 0.78 +/- 0.15 ; m +/- SD) were included in a double-blind randomized parallel s tudy to compare the effects of a 6 month treatment with CIL (10 mg per day ; n = 6) to those of placebo (PL ; n = 7) Blood pressure, AAI and arterial compliance were determined at baseline (MO) and after 3 (M3) and 6 months (M6). Common carotid (CC) and common femoral (CF) artery compliances were noninvasively determined from pulsatile changes in a rterial diameter (Wall Track System, Hoeks et al., 1990) and pressure (PP). Results : Both groups were comparable at MO. Compared to PL, CIL significantly reduced PP (- 22 +/- 4 vs - 2 +/- 9 mmHg) and MAP (- 16 +/- 11 vs - 4 +/- 7 mmHg) and improved CC (+ 54 +/- 34 vs + 5 +/- 21 mm2.mmHg-1 . 10(-3)) at M6. Weaker effects were observed at M3. No sig nificant changes in AAI and CF compliance were observed. Conclusions : A direct effect of CIL on the large artery wall was suggested by 1) a greater reduction in PP than in MAP and 2) a disproportionately great er improvement in CC compliance compared with the reduction in distend ing pressure (MAP). These results indicate that long-term treatment wi th CIL may improve large artery function in patients with LEAD.