Changes in arterial structure and function under trandolapril-verapamil combination in hypertension

Background and Purpose-Converting enzyme inhibition and calcium blockade al ter large arteries in hypertension. However, the heterogeneity of the respo nse according to the site of cardiovascular measurements has never been inv estigated. Methods-In a double-blind study, we compared for 180 days 3 hypertensive pa tient groups treated with verapamil, trandolapril, or their combination. Us ing echo-Doppler technique and applanation tonometry, we independently meas ured mean pressure, local pulse pressure, arterial diameter, and distensibi lity at 3 arterial sites (brachial and common carotid arteries and abdomina l aorta), as well as cardiac and carotid wall structure. Results-Mean and pulse pressure decreased significantly to a greater extent with the drug combination. Regarding arterial and cardiac hemodynamics, si gnificant and similar changes were noted in the 3 groups: decreases in abdo minal aorta and carotid but not brachial diameter; increases in carotid art ery, abdominal aorta, and brachial distensibility even after adjustment to mean blood pressure reduction; and more substantial regression of cardiac m ass than carotid wall thickness. Conclusions-This study shows that both compounds and more significantly com bination therapy decreased mean and pulse pressures measured independently and that the changes in diameter, thickness, and stiffness were influenced primarily by the site of cardiovascular measurements, resulting in a plt do minant increase in distensibility of muscular arteries, little change in ca rotid wall thickness, but a significant regression of cardiac hypertrophy.