Angiotensin type 1 receptor antagonism reverses abnormal coronary vasomotion in atherosclerosis

OBJECTIVES This study was performed to determine whether angiotensin type 1 (AT1) receptor inhibition improves abnormal coronary vasomotion and endothelial dysfunction in patients with atherosclerosis or its risk factors. BACKGROUND Endothelial dysfunction, an early feature of atherosclerosis, contributes to abnormal vasomotion during stress. Angiotensin II may contribute to endothelial dysfunction in atherosclerosis. METHODS In 25 patients, mean age 59 ± 2 years, with atherosclerosis or its risk factors, we measured coronary vasomotion during flow-mediated dilation (FMD) in response to adenosine, cold pressor test (CPT) and exercise before and after AT1 receptor blockade with intracoronary losartan (5 mg). RESULTS Losartan did not alter resting coronary vascular tone, but epicardial FMD improved from 5.6 ± 1.5% to 8.9 ± 1.8% (p = 0.02). Abnormal epicardial vasomotion during CPT and exercise also improved with losartan from −1.7 ± 0.8% to 1.5 ± 0.1% (p = 0.02) and −0.6 ± 0.9% to 3.4 ± 1.2% (p = 0.009), respectively. Improvement in epicardial vasomotion was most prominent in segments with baseline endothelial dysfunction evidenced as constriction during stress. Microvascular dilation during adenosine, an endothelium-independent response, was unchanged with losartan. CONCLUSIONS Inhibition of the coronary vascular AT1 receptors in patients with atherosclerosis improves epicardial vasomotion during stress, probably by improving endothelial dysfunction. Whether AT1 receptor blockade will provide long-term therapeutic benefits in atherosclerosis needs further investigation.