Key result
Pathological brachial artery vasoconstriction during reactive hyperemia predicted a lack of pulmonary artery pressure reduction after perindopril or valsartan treatment in patients with severe COPD.
Why the study?
To analyze pathological reactions of the brachial artery during reactive hyperemia testing for endothelial function estimation and their significance in treating patients with COPD.
Does perindopril or valsartan reduce pulmonary artery pressure in COPD patients, and is this effect predicted by brachial artery endothelial function?
Observational (n=60)
No
Does perindopril or valsartan reduce pulmonary artery pressure in COPD patients, and is this effect predicted by brachial artery endothelial function?
Pathological vasoconstriction of the brachial artery during reactive hyperemia testing predicts a lack of efficacy of perindopril or valsartan in reducing pulmonary hypertension in patients with severe COPD.
Background. The purpose of this study was to analyse the pathological reactions of brachial artery (BA) during test with reactive hyperemia (RH) for endothelial function (EF) estimation and their applicable significance in treatment of patients with chronic obstructive pulmonary disease (COPD). Material and methods. There were investigated 61 patients, mean age 47,7±5,11 years with moderate to severe forms of COPD (by GOLD criterion). Endothelial dysfunction (ED) estimation was performed non-invasive, using probe with RH with brachycephalic arteries Duplex with high resolution 8,0-10,0 MHz („Logiq S8” „General Electric”, SUA) by David S. Celermajer proposed method. ED was considered when EF index was less than 10%. Results. The analysis of obtained data revealed considerable decreasing of EF: mean EF index was 7,14±11,22%, between -15,0% and 29,4%. In 10 patients after RH test was noted pathological reaction of BA: instead of awaited endothelialdependent BA dilatation, there were observed spastic and negative reactions (in limits between 0% and −15,0%). In parallel there were visualized in a. carotis solitary and binary atherosclerotic plagues with 20-40% of vascular stenosis without any clinical manifestations. The levels of total cholesterol and LDL-C also were elevated: 7,5±2,0 mm/l и 4,7±1,8 mm/l, respectively. In all 10 patients with pathological BA reactions do not reduced mean and systolic pulmonary artery pressure after 5 weeks of treatment with perindopril (mean dose 2,9±1,5 mg once daily) or valsartan (mean dose 54,5±15,4 mg once daily). Conclusions. Thus, BA pathological reaction during RH test for ED estimation may be used like a criterion predictor of efficacity of treatment with perindopril or valsartan and for prognosis of survival in patients with severe forms of COPD.
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Martiniuc et al. (2024) conducted an observational in Chronic obstructive pulmonary disease (COPD) (n=60). Perindopril or Valsartan vs. Baseline was evaluated on Endothelial vascular function (%) (p=0.032). Pathological brachial artery vasoconstriction during reactive hyperemia predicted a lack of pulmonary artery pressure reduction after perindopril or valsartan treatment in patients with severe COPD.
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