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(Circulation. 1996;93:1380-1387.)
© 1996 American Heart Association, Inc.
Articles |
Normalization of Abnormal Coronary Vasomotion by Calcium Antagonists in Patients With Hypertension
From Cardiology, University Hospital, Zürich, Switzerland.
Correspondence to O.M. Hess, MD, Cardiology, University Hospital, Rämistr 100, 8091 Zürich, Switzerland.
Background Endothelial dysfunction with a loss of endothelium-dependent vasodilation has been reported in patients with arterial hypertension. The purpose of the present study was to evaluate coronary vasomotor response to dynamic exercise in patients with coronary artery disease with and without arterial hypertension and to determine the effect of calcium antagonists on coronary vasomotion.
Methods and Results Cross-sectional areas of a normal
and a stenotic coronary vessel segment were examined in
79 patients with coronary artery disease at rest and during
supine bicycle exercise (Ex). Change in luminal area after acute
administration of a calcium antagonist (diltiazem or
nicardipine), during exercise, and after sublingual
nitroglycerin (percent change compared with rest=100%)
was assessed by biplane quantitative coronary arteriography.
Patients were divided into two groups: Group 1 (control) consisted of
48 patients without (normotensive subjects, n=30; hypertensive
subjects, n=18) and group 2 of 31 patients with (normotensive subjects,
n=15; hypertensive subjects, n=16) pretreatment with a calcium
antagonist immediately before exercise. The groups did not
differ with regard to clinical characteristics or
hemodynamic data measured during exercise. Mean aortic
pressure at rest, however, was significantly increased in hypertensive
patients compared with normotensive subjects in group 1 (103 mm Hg
versus 92 mm Hg, P<.01) and group 2 (110 mm Hg versus 98 mm
Hg, P<.025). In group 1, exercise-induced vasomotor
response was significantly different between normotensive and
hypertensive patients in normal (+20% versus +1%, P<.003)
and stenotic vessels (-5% versus -20%,
P<.025). However, in group 2 there was coronary
vasodilation in normotensive and hypertensive patients for both normal
(
Ex +23% versus +21%, P=NS) and stenotic vessel
segments (+24% versus +26%, P=NS).
Conclusions Abnormal coronary vasomotion during exercise can be observed in hypertensive patients with reduced vasodilator response in normal arteries and enhanced vasoconstrictor response in stenotic arteries. Calcium antagonists prevent the abnormal response of normal and stenotic coronary arteries to exercise in hypertensive patients and thus may compensate for endothelial dysfunction with reduced vasodilator response to exercise.
Key Words: arteries • hypertension • vasoconstriction • vasodilation • exercise
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