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| |  ESH: Quinopril and L-Arginine Improves Endothelial Function In Hypertensive Patients By Bruce Wilson Special to DG News
MILAN, ITALY -- June 21, 2001 -- Combined therapy with the angiotensin-converting enzyme (ACE) inhibitor, quinapril and oral L-arginine (L-arg) may be more effective than quinopril alone in protecting endothelial function among patients with primary hypertension, say researchers at the 11th European Society of Hypertension meeting here this week. According to Dr. M. Malczewska-Malec, Department of Clinical Biochemistry Collegium Medicum Jagiellonian University, Kraków, Poland, the aim of the study was to assess the influence of quinapril and L-arg, a substrate for nitrous oxide (NO) production on blood lipids and biochemical markers of endothelial dysfunction in patients with primary hypertension. Dr. Malczewska-Malec explained that endothelial dysfunction in primary hypertension is partly related to the reduced availability of NO, which may be caused by an increase in ACE activity. ACE inhibitors are thought to improve endothelial dysfunction by increasing the availability of NO. In the double-blind, placebo-controlled study, 10 patients (five men, five women) with mild or moderate hypertension, dyslipoproteinemia and a body mass index > 25 kg/m2 were treated with quinapril (20 mg/day). After one month of treatment, all patients were randomized to receive additional oral L-arg 6 g/day or placebo for one month. According to Dr. Malczewska-Malec, after one month of treatment, blood pressure decreases were similar in all patients in the trial and came within the normal range (i.e. mean systolic blood pressure [SBP] decreased from 170 mm Hg to 124 mm Hg, mean diastolic blood pressure [DBP] from 106 mm Hg to 84 mm Hg). At two months, the mean SBP/DBP in the patients treated with quinopril plus L-arg was 118/78 mm Hg. In patients treated with quinapril and placebo the mean blood pressure was 122/82 mm Hg. According to Dr. Malczewska-Malec, "L-arg did not potentiate the beneficial effects of quinopril on blood pressure and no significant changes were observed in total plasma lipid concentration in either group. However, a decreased prevalence of proatherogenic, small, dense [low-density lipoprotein] LDL particles and a higher proportion of large, less atherogenic LDL particles was seen with quinapril, and a non-significant decline in von Willebrand factor was seen in patients taking both quinapril and L-arg. Quinapril increased the generation of nitrite and nitrate (NO2, NO3), especially after one month of treatment, whereas L-arg had no effect on NO2/NO3 levels. Exercise-induced endothelin concentration was not changed after therapy." Dr. Malczewska-Malec concluded that the beneficial effect of quinapril in patients with hypertension is not only related to its blood pressure lowering effect, but also on its ability to protect the endothelium. Adding L-arg to the ACE inhibitor seems to have an additional benefit, he said.
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