Effects of an ACE Inhibitor and a Calcium Channel Blocker on Cardiovascular Autonomic Nervous System and Carotid Distensibility in Patients with Mild to Moderate Hypertension

We investigated the relationship between cardiovascular autonomic nervous system function and carotid arterial distensibility during treatment with an angiotensin converting enzyme inhibitor (derapril) or a calcium channel blocker (manidipine) for hypertension. In 37 patients with hypertension, autonomic function was assessed by heart rate variability and baroreceptor sensitivity using phenylephrine injection. Left ventricular mass index and carotid arterial distensibility were assessed by ultrasound examinations. Before the medication, both baroreceptor sensitivity and heart rate variability correlated with carotid arterial distensibility, but not with left ventricular mass index by multiple regression analysis. Subsequently, patients were randomly allocated into two groups, derapril (n = 18) and manidipine (n = 19) for 20 weeks. At the end of the study, the change in baroreceptor sensitivity correlated with change in carotid arterial distensibility (r = 0.41, P< .05), but not with change in left ventricular mass index. Although derapril and manidipine decreased blood pressure and left ventricular mass index to the same extent, the former improved heart rate variability, baroreceptor sensitivity (5.0 ± 1.9 → 5.6 ± 2.0 msec/mm Hg), and carotid arterial distensibility (2.1 ± 0.8 → 2.5 ± 1.0 %kPa), but the latter did not improve them at all. Thus, impairment of the autonomic balance was related to the impairment of carotid arterial distensibility in hypertension; derapril, but not manidipine, significantly improved these abnormalities. Article Outline • Methods • Subjects • Study protocol • Blood pressure measurements • Ultrasonographic examinations of the heart and carotid artery • Assessment of heart rate variability • Assessment of baroreceptor sensitivity • Statistical analysis • Results • Discussion • Relationship between baroreceptor sensitivity, heart rate variability, left ventricular mass index, and arterial distensibility • Arterial distensibility and antihypertensive medication • Autonomic function and antihypertensive therapy • Clinical implication and limitations • Conclusion • References