Remodeling of Resistance Arteries in Human Hypertension: Effects of Cilazapril, an Angiotensin- I -Converting Enzyme Inhibitor

Studies on the effect of antihypertensive agents on resistance arteries in hypertensive patients have in the past yielded inconclusive results regarding the ability of these drugs to induce a regression toward normal of either the structure or the function of these critically important vessels. We have recently compared the effects of the angiotensin-I-converting enzyme inhibitor cilazapril and of the beta blocker atenolol on the structure and the function of subcutaneous resistance arteries of essential hypertensive patients. The patients were randomly assigned to receive either cilazapril or atenolol for a period of 2 years. The blood pressure was normalized for the duration of the trial by both drugs. The media-to-lumen ratio of resistance arteries, which was significantly increased in all hypertensive patients before starting treatment, was normalized by the 2-year treatment with cilazapril, whereas treatment with atenolol did not result in any change in this vascular parameter. Treatment with cilazapril also returned to normal the contractile responses to several vasoconstrictors, particularly endothelin 1. Endothelium-dependent relaxation responses of blood vessels to acetylc