Long-term treatment with ramipril favourably modifies the haemostatic response to acute submaximal exercise in hypertensives

Introduction: Hypertension links to a prothrombotic state driven by endothelial dysfunction, reduced fibrinolytic potential and platelet hyperactivity. We hypothesized that ramipril treatment would favourably modify the haemostatic response to a submaximal aerobic exercise session in hypertensives. Methods: Twenty-four hypertensive patients underwent a submaximal exercise test before and after 13±2 months of treatment with ramipril ± hydrochlorothiazide. Hypercoagulability (prothrombin fragments (PF1+2), thrombin- antithrombin complex (TAT) and D-dimers (Dd)), fibrinolytic activity (plasmin-a2-antiplasmin complex (PAP)), endothe- lial function (von Willebrand factor (vWf) and soluble thrombomodulin (sTM)), and platelet function (soluble P-selectin (sPsel)) were measured before, at peak and one hour after exercise. Results: Antihypertensive treatment resulted in an increase of PAP, vWf and sTM. During the first exercise, PF1+2 were mildly increased at peak exercise (p<0.05), while D-dimers, PAP and vWf varied significantly throughout the exercise (p<0.001). During the second exercise session, PF1+2 were decreased post-exercise (p<0.05), PAP was increased at peak and post-exercise (p<0.001) and vWf was increased at peak (p<0.05) and post-exercise (p<0.001). Conclusions: The haemostatic response to exercise in hypertensives after approximately one year of ramipril treatment is characterized by the attenuated activation of coagulation, enhanced fibrinolysis and endothelial activation.