Enalapril Is Superior to Lisinopril in Improving Endothelial Function without a Difference in Blood–Pressure–Lowering Effects in Newly Diagnosed Hypertensives

Figures

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  Figure 1. Different effects of enalapril and lisinopril on arterial endothelial function in hypertensive patients. Patients were tested for hypertension in the outpatient facility of the Department of Neurology. Newly identified hypertensive patients were enrolled in the study. Vascular parameters, such as flow-mediated dilation (panel (A)), intima-media thickness (panel (B)), augmentation index (panel (C)), and pulse wave velocity (panel (D)) were determined. Each symbol represents an individual patient. Lines connect values before and after enalapril or lisinopril treatment. Significant differences between values determined before and after the initiation of ACEi medication are labeled by the p values. Statistical differences were calculated by the Wilcoxon test.

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  Figure 2. Similar effects of enalapril and lisinopril on pulse pressure in hypertensive patients. Newly identified hypertensive patients were enrolled in the study at the outpatient facility of the Department of Neurology. Systolic and diastolic blood pressure values were determined using 24 h ambulatory blood pressure monitoring (peripheral blood pressure) and arteriography (aortic blood pressure). The difference between the systolic and diastolic blood pressure values was calculated to yield pulse pressure. Each symbol represents an individual patient. Bars represent the mean and SD for aortic (panel (A)) and peripheral (panel (C)) pulse pressure values. No significant differences were found among the groups (indicated by NS) by Kruskal–Wallis tests. Lines connect values before and after enalapril or lisinopril treatment in the case of aortic (panel (B)) and peripheral (panel (D)) pulse pressure values. Significant differences between values determined before and after the initiation of ACEi medication are labeled by the p values. Statistical differences were calculated by the Wilcoxon test.

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  Figure 3. Same anti-hypertensive effects of enalapril and lisinopril on systolic blood pressure in hypertensive patients. Newly identified hypertensive patients were enrolled in the study at the outpatient facility of the Department of Neurology. Systolic blood pressure values were determined using 24 h ambulatory blood pressure monitoring (peripheral blood pressure) and arteriography (aortic blood pressure). Each symbol represents an individual patient. Bars represent the mean and SD for aortic (panel (A)) and peripheral (panel (C)) systolic blood pressure values. No significant differences were found among the groups (indicated by NS) by Kruskal–Wallis tests. Lines connect values before and after enalapril or lisinopril treatment in the case of aortic (panel (B)) and peripheral (panel (D)) systolic blood pressure values. Significant differences between values determined before and after the initiation of ACEi medication are labeled by the p values. Statistical differences were calculated by the Wilcoxon test.

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  Figure 4. Same anti-hypertensive effects of enalapril and lisinopril on systolic blood pressure in hypertensive patients. Newly identified hypertensive patients were enrolled in the study at the outpatient facility of the Department of Neurology. Diastolic blood pressure values were determined using 24 h ambulatory blood pressure monitoring (peripheral blood pressure) and arteriography (aortic blood pressure). Each symbol represents an individual patient. Bars represent the mean and SD for aortic (panel (A)) and peripheral (panel (C)) diastolic blood pressure values. No significant differences were found among the groups (indicated by NS) by Kruskal–Wallis tests. Lines connect values before and after enalapril or lisinopril treatment in the case of aortic (panel (B)) and peripheral (panel (D)) diastolic blood pressure values. Significant differences between values determined before and after the initiation of ACEi medication are labeled by the p values. Statistical differences were calculated by the Wilcoxon test.

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  Figure 5. No correlation between anti-hypertensive effects and endothelial function improvement (FMD) upon short-term ACEi treatment in hypertensive patients. Newly identified hypertensive patients were enrolled in the study at the outpatient facility of the Department of Neurology. Increases in flow-mediated dilation (FMD) were plotted as the function of the decrease in systolic blood pressure before and after enalapril (panel (A)) and lisinopril (panel (B)) treatments. Each symbol represents an individual patient. The correlation between the parameters was tested by Spearman’s test. Correlations were characterized statistically by the rho and p values. Correlation is considered to be significant when p < 0.05.