Remodeling of myocardium and arteries by chronic angiotensin converting enzyme inhibition in hypertensive patients

AIM: To investigate changes in left ventricular hypertrophy and diastolic function in hypertensive patients treated with an angiotensin converting enzyme (ACE) inhibitor. METHODS: Structural and functional changes in the heart and iliac artery were studied by echocardiography and intraluminal ultrasound in 15 hypertensive patients following 6 months of treatment with the ACE inhibitor quinapril at 10-40 mg/day. RESULTS: Systolic/diastolic blood pressure was reduced from 156/100 mmHg to 128/82 mmHg within 2 months and remained stable during the next 4 months of the study. The left ventricular mass index was significantly reduced from 174 +/- 86 to 161 +/- 75 g/m2 (-7.4%, P < 0.05). The reduction in left ventricular hypertrophy was associated with a trend towards an improvement in diastolic function, but left ventricular systolic function did not change. There was a 3.9% increase in iliac lumen area and a significant decrease of 10.7% (P < 0.05) in the ratio between the intimal-medial and lumen area, which represents a decrease in wall thickness. A key result was a statistically significant decrease in pulse-wave velocity, from 13.7 +/- 2.6 to 12.1 +/- 2.0 m/s, and in the modulus of elasticity, from 20.5 +/- 7.2 to 15.8 +/- 5.6 x 10(4) N/m2 (P < 0.05). CONCLUSION: The present study demonstrates that 6 months of treatment with an ACE inhibitor induced a significant regression in left ventricular hypertrophy and a reduction in wall thickness. In addition, the results indicate that chronic ACE inhibition can decrease the stiffness of large elastic arteries independently of a reduction in blood pressure.