Issue 175 Item 12 More Than ACE Inhibition” Needed to Prevent Vascular Damage in

Treatment with an ACE inhibitor did not prevent vascular remodeling or improve media to lumen ratio.

The study results, from investigators at the Clinical Research Institute of Montreal, were completely unexpected, said senior researcher Dr. Ernesto L. Schiffrin, who also chaired this year’s meeting. "These findings suggest that the vascular remodeling seen in diabetic patients may be difficult to correct with just ACE inhibition, and we may need to consider other approaches," Dr. Schiffrin said.

"Dr. Grim from the Medical College of Wisconsin, Milwaukee said that he was astounded by the results and was surprised that the researchers were not saying more about the findings. If the study had been positive, they would have been telling us to put everyone on an ACE." But since the study is small, and is not a controlled study, Dr. Grim said it is difficult to "know what to make of it."

Dr. Dierk Endemann, who presented the results, said the study enrolled 8 normotensive volunteers, 19 untreated hypertensive patients and 23 patients with type 2 diabetes and hypertension who were receiving antihypertensive medication, more than 75% of whom were taking ACE inhibitors.

The diabetic patients were generally older–average age 58–compared with an average age of 45 in the other two arms. They were also more likely to be obese: with a median BMI of 30 compared with a BMI of 24 among the normotensive controls and 27 in the untreated hypertensives.

Resistance arteries were dissected form gluteal subcutaneous biopsies and assessed using a pressurized myograph.
Generally, the treated diabetics had better diastolic pressures than the untreated hypertensive patients, but "systolic blood pressures still were in the upper limits," said Dr. Endemann. In resistance arteries, the media to lumen ratio was significantly increased in hypertensive patients (8.5%) compared to controls (5.9%; p < 0.05), he said. But the difference was most pronounced in the diabetic patients, who had an average increase of 9.4%. Moreover the media thickness was significantly higher in diabetics. Asked if the findings suggest the need to rethink ACE inhibition for diabetic patients, Dr. Endemann said no. "We know that ACE inhibition is of value in diabetics," he said. "We just don’t know if it is enough

Presented Thursday at the American Heart Association’s 57th Annual High Blood Pressure Research Conference.