Assessment of effect of perindopril on blood pressure, vascular remodeling, and microcirculation in hypertensive disease

Antihypertensive efficacy, action on elastic properties of large vessels an d microcirculation of an angiotensin converting enzyme inhibitor perindopri l was studied in 30 patients with stage I-II hypertensive disease (15 women , mean age 50.6+/-7.56 years). Twenty four hour blood pressure monitoring, M-mode echocardiography and study of microcirculation by laser doppler flow metry were carried out before and after 4 weeks of treatment. Therapy with perindopril was associated with significant lowering of total peripheral va scular resistance, average 24-hour, diurnal and nocturnal systolic, diastol ic, and mean blood pressures, pulse pressure, index of area of hypertension , and hypertensive burden for systolic, diastolic and mean blood, pressures more pronounced during sleep. Perindopril did not affect blood pressure va riability, heart rate and its standard: deviation. Dynamics of elastic prop erties of large vessels was assessed by measurement of a ratio <<stroke vol ume/pulse pressure x 100%>> which significantly increased in this study. Th e following parameters increased during treatment: index of microcirculatio n, amplitude of slow and pulse fluctuations, degree of lowering of microcir culation index during breath hold test (p<0.05). These changes reflected, r estoration of proper contractile activity of precapillary sphincters and im provement of venulo-arteriolar reactions (so called <<myogenic>> endothelia l-dependent reactions). Thus perindopril in addition to hypotensive effect improved vascular elasticity and produced positive action on microcirculati on and endothelial dysfunction.