EFFECTS OF PERINDOPRIL AND CARVEDILOL ON ENDOTHELIUM-DEPENDENT VASCULAR FUNCTIONS IN PATIENTS WITH DIABETES AND HYPERTENSION

OBJECTIVE- To compare the effects of the ACE inhibitor perindopril and the beta-blocker carvedilol on blood pressure and endothelial functio ns in NIDDM patients with hypertension. RESEARCH DESIGN AND METHODS- W e conducted a double-blind randomized trial in 26 patients with NIDDM and mild hypertension. A 4-week run-in placebo period preceded the act ive 12-week treatment with perindopril (4-8 mg daily) or carvedilol (2 5-50 mg daily). Endothelial functions were assessed by evaluating the hemodynamic (mean blood pressure, leg blood flow) and rheological (pla telet aggregation, blood viscosity, and blood filterability) responses to an intravenous bolus of 3 g L-arginine, the natural precursor of n itric oxide. RESULTS- Both perindopril and carvedilol significantly re duced mean blood pressure (P < 0.001) and increased leg blood now (P < 0.05) to the same extent; blood filterability remained unchanged in b oth perindopril-and carvedilol-treated groups. Carvedilol reduced plat elet aggregation and blood viscosity significantly (P < 0.05) but peri ndopril did not. Before treatment, the hemodynamic and theologic respo nses to L-arginine were significantly lower in patients (P < 0.05-0.01 ) than in 20 nondiabetic nonhypertensive control subjects. After 12 we eks of treatment, both drugs normalized the hemodynamic responses to L -arginine. Platelet aggregation response to L-arginine was ameliorated by carvedilol and remained unchanged in the perindopril group. CONCLU SIONS- At the doses used, both drugs effectively reduce blood pressure and normalize the hemodynamic responses to L-arginine. The implicatio ns of the ameliorated endothelial function for the poor cardiovascular outlook of the NIDDM hypertensive patient need further assessment.