Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study)

OBJECTIVES To determine the effect of angiotensin-converting enzyme (ACE) i nhibition on brachial flow-mediated vasodilation. BACKGROUND Quinapril, an ACE inhibitor with high affinity, has been shown t o improve coronary endothelial dysfunction in patients with coronary artery disease. The effectiveness of different vasoactive agents to improve human endothelial function is unknown. METHODS High resolution ultrasound was used to assess endothelium-dependent brachial artery flow-mediated vasodilation (FMD) in patients with coronary disease. We studied 80 patients (mean age 58 +/- 0.9 years) in a partial-b lock, cross-over design trial. Patients were randomized to one of four diff erent drug sequences to receive quinapril 20 mg, enalapril 10 mg, losartan 50 mg or amlodipine 5 mg daily. Each patient received three drugs with a tw o-week washout period between treatments. The primary end point was the abs olute difference in FMD after eight weeks of each study drug compared with their respective baselines analyzed in a blinded fashion. RESULTS There was mild impairment of FMD at baseline (7.3 +/- 0.6%). The ch ange in FMD from baseline was significant only for quinapril (1.8 +/- 1%, p < 0.02). No change was seen with losartan (0.8 +/- 1.1%, p = 0.57), amlodi pine (0.3 +/- 0.9%, p = 0.97) or enalapril (-0.2 +/- 0.8%, p = 0.84). No si gnificant change in nitroglycerin-induced dilation occurred with drug thera py. The improvement in quinapril response was not seen in those with the DD ACE genotype (0.5 +/- 2.1%) but was seen in those with the ID and II genot ype (3.3 +/- 1.2 and 3.2 +/- 1.9%, respectively, p = 0.03). CONCLUSION Only quinapril was associated with significant improvement in FM D, and this response is related to the presence of the insertion allele of the ACE genotype. (C) 1999 by the American College of Cardiology.