THERAPEUTIC BENEFITS OF CILAZAPRIL IN PATIENTS WITH SYNDROME-X

Objectives: Although the pathophysiology of syndrome X (angina pectori s, positive ECG test findings and normal coronary arteriogram) is uncl ear, it is generally accepted that intracellular metabolic changes res ulting from abnormal constriction of prearteriolar vessels due to endo thelium-dependent vasodilation abnormalities may play a role in the pa thogenesis. We established the effect of long-term treatment with cila zapril, an angiotensin-converting enzyme inhibitor, which prevents the effect of angiotensin II in the tonic control of vascular resistance. Methods: 18 patients (15 women and 3 men, mean age 43.2 +/- 4.6 years ) with syndrome X were included in this study. A randomized double-bli nd crossover placebo-controlled trial was done. After a 1-week washout period, patients received either cilazapril 2 x 2.5 mg or placebo for 3 weeks, followed by 3 weeks of the other therapy. At the end of two periods, an exercise ECG test (modified Bruce protocol) was employed. Results: The magnitude of ST segment depression was significantly decr eased during treatment with cilazapril compared with placebo. On the o ther hand, total exercise time and time to 1 mm ST segment depression were significantly prolonged by cilazapril. However, rate pressure pro ducts were not significantly different at peak exercise at or at 1 mm of ST segment depression during both therapies. Conclusion: Cilazapril exerted a beneficial therapeutic effect in cases with syndrome X. The possible mechanism of this effect may be a modulation of coronary ton e at the microcirculation level.