Reversal of pathophysiologic changes with long-term lisinopril treatment in isolated systolic hypertension

The purpose of this study was to evaluate in a prospective, double-blind, p lacebo-controlled study the effect of long-term (2-year) lisinopril treatme nt on cardiovascular end-organ damage in patients with previously untreated isolated systolic hypertension (ISH). All patients with ISH were derived f rom a population screening program. End-organ damage measurements, done ini tially and after 6 and 24 months of treatment, included measurements of aor tic distensibility and echocardiographic left ventricular mass index (LVMI) and diastolic function. Blood pressure was measured by office and ambulato ry measurements. Of the 97 subjects with ISH selected from the screening, 6 2 (30 lisinopril) completed the study according to protocol. Office blood p ressure decreased in both groups, but ambulatory results significantly decr eased with lisinopril-treatment only. Aortic distensibility increased signi ficantly with lisinopril, as opposed to a decrease in placebo-treated subje cts. The main effect of increased distensibility occurred between 6 and 24 months, whereas ambulatory blood pressure changed mainly in the first 6 mon ths of treatment. LVMI decreased in both treatment groups, with a significa ntly higher reduction in lisinopril-treated subjects. Left ventricular dias tolic function showed no significant changes in either group. The vascular pathophysiologic alterations of ISH-a decreased aortic distensibility-can b e improved with long-term lisinopril treatment, whereas values deteriorate further in placebo-treated subjects. These results, in one of the first stu dies including subjects with previously untreated ISH only, indicate that l isinopril treatment might favorably influence the cardiovascular risk of IS H.