Abstract 15972: Protective Effect of Angiotensin II Receptor Blocker for Impairment of Endothelial Function After Coronary Drug-Eluting Stent Implantation in Hypertensive Patients
Background: Coronary drug-eluting stent (DES) implantation impairs local endothelial function, which may be associated with future cardiovascular events. Angiotensin II receptor blockers (ARBs) have favorable effects on endothelial function. This prospective, randomized study was conducted to evaluate the effects of telmisartan as ARB on endothelial function after DES implantation in hypertensive patients, compared to a calcium channel blocker (CCB), amlodipine.
Methods: Thirty-nine hypertensive patients with coronary artery stenosis but without coronary artery spasm, treated with sirolimus-eluting stent, were randomly assigned to either telmisartan or amlodipine treatment group (ARB: 20 cases, CCB 19 cases). At baseline and after 3 months, endothelium-dependent and -independent vasomotion were evaluated with quantitative coronary angiography (QCA) under the condition of medication withdrawal. The mean luminal diameter of a 20 mm coronary segment, starting 5 mm distal to the stent, was measured before and after intracoronary acetylcholine (ACh: 10−7 M, 10−6 M) infusion, and then after nitroglycerin (NTG) infusion.
Results: Blood pressure was comparable between groups at baseline and after 3 months. Percent changes of mean luminal diameters after intracoronary ACh and NTG infusion of both groups are shown in the figure. At baseline, there were no significant differences in any QCA parameters; however, change of maximum vasoconstriction after ACh infusion between baseline and 3 months (impairment of endothelial function) was less pronounced in ARB group than in CCB group (−2.6 ± 6.3% vs −32.5 ± 27.4%, p=0.0001).
Conclusions: In this group of hypertensive patients, ARB treatment significantly reduced the degree of endothelial dysfunction after DES implantation in terms of vasoconstriction by ACh compared to CCB treatment, suggesting a vasoprotective effect of ARB in the management of hypertensive patients requiring DES.
- © 2010 by American Heart Association, Inc.