Clinical Trials in Cardiology - B

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A Comparative Study of Four Anti-hypertensive Agents on Endothelial Function in Patients With Coronary Disease T.J. Anderson1, R.W. Overhiser, H. Haber, F. Charbonneau

Background: Quinapril, an ACE inhibitor with high affinity, has been shown to improve coronary endothelial dysfunction in patients with CAD. The effectiveness of different vasoactive agents to improve human endothelial function is unknown. In the BANFF study, we used high resolution ultrasound to compare the chronic effects of four anti-hypertensives on brachial artery flow-mediated vasodilation (FMD) in patients with documented CAD. Methods: Patients were enrolled in a partial-block, cross-over design trial, and randomized in one of four different, open label drug sequences. The core ultrasound lab and data analysis center were masked to treatment. FMD and NTG-induced dilation were evaluated before and after 8 weeks of each study drug. Two week washout was imposed between treatments.
Results: CAD patients had significantly impaired FMD (6.2 ± 0.6%, n = 80) compared to normals (10.9 ± 0.8%, N = 40, p < 0.05). Absolute changes in FMD from baseline are shown below.

 
Drug	         N	 Change FMD (Mean ± SE)	   p value 
Quinapril 20 mg	 56	 1.8 ± 1.0%	           <0.02 
Enalapril 10 mg	 55	 -0.2 ± 0.8%	           0.84 
Losartan  50 mg	 38	 0.8 ± 1.1%	           0.57 
Amlodipine 5 mg	 45	 0.3 ± 0.9%	           0.97 

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