This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gokce, N. Articles by Vita, J. A. Search for Related Content PubMed PubMed Citation Articles by Gokce, N. Articles by Vita, J. A.

CLINICAL STUDY: ENDOTHELIAL FUNCTION ASSESSMENT

Acute effects of vasoactive drug treatment on brachial artery reactivity

^* Evans Department of Medicine, Cardiology Section and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA

Manuscript received February 22, 2002; revised manuscript received April 19, 2002, accepted May 7, 2002.

^* Reprint requests and correspondence: Dr. Joseph A. Vita, Section of Cardiology, Boston Medical Center, 88 East Newton Street, Boston, Massachusetts 02118 USA.
jvita{at}bu.edu

OBJECTIVES: The goal of this study was to investigate whether concomitant therapy with vasoactive medications alters the results of noninvasive assessment of endothelial function.

BACKGROUND: Ultrasound assessment of brachial artery flow-mediated dilation is emerging as a useful clinical tool. The current practice of withholding cardiac medications before ultrasound studies has unknown utility and would limit the clinical use of the methodology.

METHODS: To determine whether a single dose of a vasoactive drug influences brachial reactivity, we examined flow-mediated dilation and nitroglycerin-mediated dilation in 73 healthy subjects (age 27 ± 6 years). Studies were completed at baseline and 3 h after randomized treatment with a single oral dose of placebo, felodipine (5 mg), metoprolol (50 mg), or enalapril (10 mg). To determine if holding vasoactive therapy for 24 h before study yields different results than continuation of clinically prescribed medications, we examined vascular function in 72 patients (age 57 ± 10 years) with coronary artery disease. Ultrasound studies were performed 24 h after the last dose and again 3 h after patients took their clinically prescribed medications.

RESULTS: In healthy subjects one dose of all three drugs lowered blood pressure, and metoprolol also lowered heart rate. However, there was no significant effect of treatment on brachial artery dilation. In patients with coronary artery disease on chronic treatment, taking prescribed medications reduced blood pressure and heart rate, but had no significant effect on brachial artery dilation.

CONCLUSIONS: Recent administration of commonly used nonnitrate vasoactive drugs has no significant effect on brachial reactivity. These findings suggest that current practice of withholding cardiac medications before testing endothelial function may not be necessary, making this methodology more practical for clinical use.

Abbreviations and Acronyms   ACE   angiotensin-converting enzyme   ANOVA   analysis of variance   BMI   body mass index   CAD   coronary artery disease   FMD   flow-mediated dilation   NMD   nitroglycerin-mediated dilation

This article has been cited by other articles:

				H. A Chami, M. J Keyes, J. A Vita, G. F Mitchell, M. G Larson, S. Fan, R. S Vasan, G. T O'Connor, E. J Benjamin, and D. J Gottlieb Brachial artery diameter, blood flow and flow-mediated dilation in sleep-disordered breathing Vascular Medicine, November 1, 2009; 14(4): 351 - 360. [Abstract] [PDF]

				J. A. Vita, M. Holbrook, J. Palmisano, S. M. Shenouda, W. B. Chung, N. M. Hamburg, B. R. Eskenazi, L. Joseph, and O. M. Shapira Flow-Induced Arterial Remodeling Relates to Endothelial Function in the Human Forearm Circulation, June 17, 2008; 117(24): 3126 - 3133. [Abstract] [Full Text] [PDF]

				A. L. Huang, A. E. Silver, E. Shvenke, D. W. Schopfer, E. Jahangir, M. A. Titas, A. Shpilman, J. O. Menzoian, M. T. Watkins, J. D. Raffetto, et al. Predictive Value of Reactive Hyperemia for Cardiovascular Events in Patients With Peripheral Arterial Disease Undergoing Vascular Surgery Arterioscler Thromb Vasc Biol, October 1, 2007; 27(10): 2113 - 2119. [Abstract] [Full Text] [PDF]

				M. Petersson, P. Friberg, G. Lambert, and B. Rundqvist Decreased renal sympathetic activity in response to cardiac unloading with nitroglycerin in patients with heart failure Eur J Heart Fail, October 1, 2005; 7(6): 1003 - 1010. [Abstract] [Full Text] [PDF]

				K. B. Vallbracht, P. L. Schwimmbeck, U. Kuhl, U. Rauch, B. Seeberg, and H.-P. Schultheiss Differential Aspects of Endothelial Function of the Coronary Microcirculation Considering Myocardial Virus Persistence, Endothelial Activation, and Myocardial Leukocyte Infiltrates Circulation, April 12, 2005; 111(14): 1784 - 1791. [Abstract] [Full Text] [PDF]

				K. B. Vallbracht, P. L. Schwimmbeck, U. Kuhl, B. Seeberg, and H.-P. Schultheiss Endothelium-Dependent Flow-Mediated Vasodilation of Systemic Arteries Is Impaired in Patients With Myocardial Virus Persistence Circulation, November 2, 2004; 110(18): 2938 - 2945. [Abstract] [Full Text] [PDF]

				E. J. Benjamin, M. G. Larson, M. J. Keyes, G. F. Mitchell, R. S. Vasan, J. F. Keaney Jr, B. T. Lehman, S. Fan, E. Osypiuk, and J. A. Vita Clinical Correlates and Heritability of Flow-Mediated Dilation in the Community: The Framingham Heart Study Circulation, February 10, 2004; 109(5): 613 - 619. [Abstract] [Full Text] [PDF]