PHILADELPHIA -- A symposium exploring research on the significance of vascular function and how it may alter the current paradigm on cardiovascular disease was held here Wednesday evening during the (ACP).

Sponsored by the University of Minnesota Medical School, "What is Vascular Compliance and How Does It Affect Cardiovascular Risk?" featured presentations from leading researchers on how structural changes in arteries over time may play a role in the development of cardiovascular disease, such as high blood pressure.

"There is a growing body of evidence that a decrease in vascular compliance -- or 'stiffening' of the arterial wall -- may be an early warning sign for the development of a variety of cardiovascular diseases," said symposium chairman William H. Frishman, MD, Chairman, Department of Medicine at New York Medical College, Valhalla, NY. "These research findings may have a profound effect on the way we diagnose and treat various cardiovascular diseases, including arteriosclerosis, systemic hypertension and diabetes."

During the symposium, researchers highlighted the importance of viewing high blood pressure not simply as a disease of numbers, but a manifestation of the "hypertension syndrome," an inherited set of risk factors leading to the development of cardiovascular disease. Moreover, contrary to long-held beliefs, high blood pressure may be a late, rather than early symptom of the syndrome, with other factors -- such as left ventricular hypertrophy, renal dysfunction and changes in arterial structure and function -- occurring years before the onset of hypertension.

Furthermore, when comparing hypertensive patients treated with high blood pressure medications to untreated patients with similar blood pressure readings, the incidence of cardiovascular disease remains approximately 30 percent higher in the those patients treated with antihypertensive medications.

"Based on the latest research, a new model for the natural progression of hypertension should be considered," said featured panelist Stephen P. Glasser, MD, Director of Graduate Studies in Clinical Research at the University of Minnesota School of Public Health, Minneapolis, MN. "The old paradigm suggested that increased blood pressure resulted in vascular and target organ damage. In some individuals, vascular and organ damage can precede elevated blood pressure, illustrated by the finding that increased arterial stiffness is found in people who are genetically predisposed to hypertension but do not yet manifest the disease."

With increased attention to preventing and reversing arterial stiffness, researchers at the symposium pointed out that the effects of antihypertensive agents such as angiotensin converting enzyme (ACE) inhibitors that go beyond the ability to reduce blood pressure are an important consideration when selecting medications. Additionally, ACE inhibitors have demonstrated greater improvement in vascular compliance than diuretics and beta-blockers at a similar level of blood pressure reduction.

"The ACE inhibitor that has been most widely studied in terms of its effect on arterial compliance is perindopril," explained Dr. Glasser. "Because of its degree of tissue penetration and long half-life, perindopril is perhaps uniquely situated in terms of its effect on the arterial wall."

Several international studies are underway to further evaluate the effect ACE inhibitors have on vascular compliance. These include the European Trial of Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA) and the Prevention of Events with ACE Inhibition (PEACE) study.

About Hypertension

Despite available treatment options, hypertension remains a major health issue. The National Center for Health Statistics estimates that only a quarter of patients with hypertension are on adequate therapy. Moreover, of the 50 million Americans who have hypertension, it is believed that one third are unaware they have the condition. From 1986-1996, the death rate from hypertension increased 11.6 percent.

In addition to presentations made by Drs. Frishman and Glasser, speakers included Joseph L. Izzo, Jr., MD, Professor of Medicine and Pharmacology at the State University of New York, Buffalo, NY; and Joel M. Neutel, MD, Chief of Clinical Pharmacology and Hypertension at the VA Medical Center, Long Beach, CA.

The symposium was supported by an unrestricted educational grant from Solvay Pharmaceuticals, Inc.

Top of Page