REGRESSION OF RADIAL ARTERY WALL HYPERTROPHY AND IMPROVEMENT OF CAROTID-ARTERY COMPLIANCE AFTER LONG-TERM ANTIHYPERTENSIVE TREATMENT IN ELDERLY PATIENTS

Objectives. The present study was designed to assess whether a diureti c- or an angiotensin-converting enzyme inhibitor-based treatment can r educe arterial mall hypertrophy of a distal muscular medium sized arte ry-the radial artery-and the stiffness of a proximal large elastic art ery-the common carotid artery, Background. Large-artery mall thickness and stiffness are increased during sustained essential hypertension a nd contribute to the increased risk of complications. Whether antihype rtensive treatment can normalize the mall hypertrophy of conducting ar teries has not yet been determined. Methods. Seventy-seven elderly hyp ertensive patients mere randomized to receive 9 months of double-blind treatment with perindopril (2 to 8 mg/day) or the diuretic combinatio n of hydrochlorothiazide (12.5 to 50 mg/day) plus amiloride (1.25 to 5 mg/day) after a 1-month placebo washout period. if systolic blood pre ssure remained at >160 mm Hg after 5 months, chlorthalidone or atenolo l mas added, respectively. Arterial variables, including radial artery mass and common carotid artery compliance, mere calculated from nonin vasive measurements of internal diameter and mall thickness with the u se of high resolution echo tracking systems at baseline and after 5 an d 9 months. Results. During treatment, blood pressure and arterial var iables changed to the same extent in both groups. After a 9-month trea tment, systolic, diastolic and pulse pressures and radial artery wall thickness, mass and thickness/radius ratio decreased significantly (p < 0.01), whereas carotid compliance increased (p < 0.001). The decreas e in radial artery thickness/radius ratio after a 9-month treatment wa s significantly related to the reduction in pulse pressure (p < 0.01), whereas the improvement in carotid compliance was related to the redu ction in mean arterial pressure (p < 0.01). In healthy subjects and un treated hypertensive patients, radial artery diameter, wall thickness and thickness/radius ratio and carotid artery compliance did not chang e significantly during a 9 month observation period. Conclusions. Thes e results indicate that in elderly hypertensive patients, both angiote nsin-converting enzyme inhibitor-and diuretic combination-based treatm ents can reduce radial artery mall hypertrophy and improve carotid art ery compliance. (C)1998 by the American College of Cardiology.