Published online before print May 28, 2002, doi: 10.1161/01.CIR.0000020500.77568.3C
(Circulation. 2002;105:2955.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Omapatrilat Reduces Pulse Pressure and Proximal Aortic Stiffness in Patients With Systolic Hypertension
Results of the Conduit Hemodynamics of Omapatrilat International Research Study
From Cardiovascular Engineering, Inc (G.F.M.), Holliston, Mass; State University of New York at Buffalo (J.L.I.), Buffalo, NY; Centre hospitalier de l’Universite Laval (Y.L.), Ste Foy, Quebec; Q&T Research, Inc (J.-P.O.), Sherbrooke, Quebec, Canada; Orange County Research Center (J.N.), Orange, Calif; Bristol-Myers Squibb Pharmaceutical Research Institute (C.Q., L.J.K., A.J.B.), Princeton, NJ; and Brigham and Women’s Hospital (M.A.P.), Boston, Mass.
Correspondence to Gary F. Mitchell, MD, Cardiovascular Engineering, Inc, 327 Fiske St, Holliston, MA 01746. E-mail GaryFMitchell{at}mindspring.com
Background— Increased pulse pressure, an indicator of conduit vessel stiffness, is a strong independent predictor of cardiovascular events in hypertensive cohorts, which suggests that reduction of conduit vessel stiffness may be desirable in hypertension.
Methods and Results— We assessed changes in pulse pressure and conduit vessel stiffness in a 12-week double-blind, randomized clinical trial that compared monotherapy with the ACE inhibitor enalapril 40 mg daily (n=87) versus the vasopeptidase (dual ACE and neutral endopeptidase) inhibitor omapatrilat 80 mg daily (n=80) in patients with systolic hypertension. Patients were withdrawn from antihypertensive medications 1 to 2 weeks before enrollment, and systolic pressure was confirmed to be 
160 mm Hg. With the use of calibrated tonometry and pulsed Doppler, pulsatile hemodynamics were assessed before randomization and at 12 weeks. Characteristic impedance (Zc), a direct measure of the stiffness of the central aorta, was calculated from the ratio of changes in carotid pressure and aortic flow in early systole. Omapatrilat compared with enalapril produced greater reductions in peripheral (-8.2±12.2 versus -4.0±12.2 mm Hg, P<0.05) and central (-10.2±16.2 versus -3.2±16.9 mm Hg, P<0.01) pulse pressures and Zc (237±83 to 208±70 versus 225±87 to 231±94 dyne · s/cm5, P<0.001); the latter remained significant (P<0.05) after adjusting for change in mean pressure.
Conclusions— Greater reductions in pulse pressure and Zc in hypertensive subjects treated with omapatrilat compared with enalapril suggest that aortic stiffness is maintained by specific, partially reversible mechanisms and underscore a potential role for pharmacological modulation of natriuretic peptides in the treatment of hypertension.
Key Words: hypertension • hemodynamics • aorta • natriuretic peptides
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