CLINICAL STUDY: ANGIOTENSIN ANTAGONISM
Augmentation of myocardial blood flow in hypertensive heart disease by angiotensin antagonists
A comparison of lisinopril and losartan
Olakunle O. Akinboboye, MD, MPH, FACC*,*,
R. u-Ling Chou, PhD and
Steven R. Bergmann, MD, PhD, FACC
* Saint Francis Hospital, Roslyn, State University of New York at StonyBrook, Roslyn, New York, USA
Division of Cardiology, Columbia University, New York, New York, USA.
Manuscript received March 12, 2002;
revised manuscript received April 29, 2002,
accepted May 9, 2002.
* Reprint requests and correspondence: Dr. Olakunle O. Akinboboye, Non-Invasive Laboratory, Saint Francis Hospital, 100 Port Washington Boulevard, Roslyn, New York 11576, USA.
ooa2{at}columbia.edu
OBJECTIVES: The goal of this study was to compare myocardial perfusion reserve (MPR) before and after long-term treatment with lisinopril and losartan in patients with hypertension and left ventricular hypertrophy (LVH).
BACKGROUND: Studies have suggested that treatment with angiotensin-converting enzyme inhibitors (ACEIs) improves MPR in patients with hypertension by potentiating endogenous bradykinins. Because angiotensin receptor blockers (ARBs) lack a direct effect on bradykinins, we hypothesized that they may not improve MPR.
METHODS: We measured pre- and post-treatment myocardial blood flow (MBF) by positron emission tomography in 17 patients (lisinopril: 9 patients, losartan: 8 patients) with hypertension and LVH at baseline and after coronary vasodilation with intravenous dipyridamole. In addition, we measured rest and hyperemic blood flow in eight normotensive controls.
RESULTS: Post-treatment maximal coronary blood flow and MPR in the lisinopril group increased significantly compared with pretreatment values (3.5 ± 1.2 vs. 2.6 ± 1.1 ml/min/g, p = 0.02; 3.7 ± 1.1 vs. 2.4 ± 1 ml/min/g, respectively, p = 0.002, respectively). Post-treatment hyperemic flow in the patients treated with lisinopril was not significantly different from corresponding measurements in controls (3.5 ± 1.2 vs. 3.9 ± 1 ml/min/g, respectively, p = NS). In the patients treated with losartan, there was no difference between pre- and post-treatment MBF values and MPR.
CONCLUSIONS: Myocardial perfusion reserve and maximal coronary flow improved in asymptomatic patients with hypertension-induced LVH after long-term treatment with lisinopril but not with losartan. Thus, ACEIs, but not ARBs, might be effective in repairing the coronary microangiopathy associated with hypertension-induced LVH.
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Abbreviations and Acronyms
| | ACEI | | angiotensin-converting enzyme inhibitor | | ARB | | angiotensin-receptor blocker | | LV | | left ventricular | | LVH | | left ventricular hypertrophy | | LVID | | left ventricular dimensions | | MBF | | myocardial blood flow | | MPR | | myocardial perfusion reserve | | PD | | posterior wall thickness | | PET | | positron emission tomography | | SD | | septal wall thickness |
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