Effects of perindopril on cardiovascular remodeling

The primary aim in the medical treatment of hypertension is to lower blood pressure (BP). A wide variety of agents have proved effective for meeting this goal. However, an ideal agent for management of hypertensive patients must also meet a number of additional criteria. It should have a significant positive impact on conditions that are likely to be associated with elevated BP and that are known risk factors for cardiovascular morbidity and mortality. This article reviews effects of the long-acting angiotensin-converting enzyme inhibitor perindopril erbumine on hypertension-associated blood vessel and myocardial remodeling known to be associated with increased cardiovascular risk. Long-term treatment with perindopril improves arterial compliance and increases the media–lumen ratio of peripheral resistance vessels. These effects appear to be at least partially independent of BP lowering. Reversal of hypertension-associated vascular remodeling with perindopril should decrease afterload and reduce or reverse left ventricular hypertrophy. Evaluation of patients who have received long-term perindopril therapy has shown this to be the case. This effect of perindopril on an important predictor of cardiovascular morbidity and mortality may also be partially independent of BP. The combination of treatment with such agents as perindopril and methods that permit early detection of vascular changes contributing to cardiovascular disease has the potential to markedly improve the prognosis for hypertensive patients and others at risk for development of cardiovascular disease.