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      Quinapril Improves Endothelial Function in Postmenopausal Hypertensive Patients

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          Abstract

          Background/Aim: Hypertension is one of the main cardiovascular risk factors, and it may be responsible for the excess morbidity and mortality in postmenopausal women. Endothelium-dependent dilation of conduit arteries is reduced in women after menopause, as shown by the reduced flow-mediated dilation (FMD) of the brachial artery. The aim of this study was to evaluate changes in FMD during and following a 6-month-long treatment with increasing doses (10, 20 and 40 mg) of quinapril in hypertensive postmenopausal patients. Methods: A multicenter, open-label, non-comparative, baseline control study in 61 postmenopausal outpatients. Results:The mean baseline FMD (% ± SD) of the 53 patients in the intent-to-treat population (patients with at least one FMD evaluation) was 2.83 ± 1.24%; FMD of the 51 subjects on 10 mg quinapril daily was 5.58 ± 2.179%; FMD of the 52 patients on 20 mg quinapril was 7.06 ± 2.31%, and FMD of the 53 subjects on 40 mg daily was 8.07 ± 2.57% (p < 0.001 for each dose, compared to baseline). Conclusion: Ourresults confirmed that quinapril improves endothelial function at all examined doses as measured by FMD. Modulation of the renin-angiotensin system may act as a target for reducing cardiovascular risk in postmenopausal hypertensive women.

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          Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery

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            Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction.

            This study attempted to assess whether coronary risk factors are associated with endothelial dysfunction in the systemic arteries of asymptomatic men and women. Endothelial dysfunction is present in adults with established atherosclerosis. It is not known whether risk factors interact to produce endothelial dysfunction in clinically well subjects early in the natural history. Using high resolution ultrasound, we measured arterial diameter at rest, after reactive hyperemia (with increased flow causing endothelium-dependent dilation) and after sublingual nitroglycerin (an endothelium-independent dilator). Arterial responses were studied noninvasively in 500 clinically well, nonhypertensive subjects (252 men, 248 women; mean [+/- SD] age 36 +/- 15 years, range 5 to 73), including 179 current and former smokers. The superficial femoral artery was studied in 46 subjects and the brachial artery in 454. Flow-mediated dilation ranged from -1% to +17%. All arteries dilated in response to administration of nitroglycerin (17 +/- 6%), suggesting an abnormality of endothelial function in subjects with impaired flow-mediated dilation. On univariate analysis, reduced flow-mediated dilation was significantly related to hypercholesterolemia, cigarette smoking, higher blood pressure, male gender, older age, family history of premature vascular disease and larger vessel size (p < 0.01). By multiple stepwise regression analysis, reduced flow-mediated dilation was independently associated with cigarette smoking, older age, male gender and larger vessel size (p < 0.005) but not with total cholesterol level, blood pressure or family history. A composite risk factor score was independently related to flow-mediated dilation (r = -0.30, p < 0.0001), suggesting risk factor interaction. Loss of endothelium-dependent dilation in the systemic arteries occurs in the preclinical phase of vascular disease and is associated with interaction of the same risk factors known to predispose to atherosclerosis and its complications in later life.
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              Menopause and the risk of coronary heart disease in women.

              To determine the relation of menopause to the risk of coronary heart disease, we analyzed data on a prospective cohort of 121,700 U.S. women 30 to 55 years old who were followed from 1976 to 1982. Information on menopausal status, the type of menopause, and other risk factors was obtained in 1976 and updated every two years by mailing questionnaires. Through 1982, the follow-up rate was 98.3 percent for mortality and 95.4 percent for nonfatal events. After we controlled for age and cigarette smoking, women who had had a natural menopause and who had never taken replacement estrogen had no appreciable increase in the risk of coronary heart disease, as compared with premenopausal women (adjusted rate ratio, 1.2; 95 percent confidence limits, 0.8 and 1.8). Again compared with premenopausal women, the occurrence of a natural menopause together with the use of estrogens did not affect the risk (rate ratio, 0.8, 95 percent confidence limits, 0.4 and 1.3). Women who had undergone bilateral oophorectomy and who had never taken estrogens after menopause had an increased risk (rate ratio, 2.2; 95 percent confidence limits, 1.2 and 4.2). However, the use of estrogens in the postmenopausal period appeared to eliminate this increased risk among these women as compared with premenopausal women (rate ratio, 0.9; 95 percent confidence limits, 0.6 and 1.6). These data suggest that, in contrast to a natural menopause, bilateral oophorectomy increases the risk of coronary heart disease. This increase appears to be prevented by estrogen-replacement therapy.
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                Author and article information

                Journal
                KBR
                Kidney Blood Press Res
                10.1159/issn.1420-4096
                Kidney and Blood Pressure Research
                S. Karger AG
                1420-4096
                1423-0143
                2008
                September 2008
                28 June 2008
                : 31
                : 4
                : 226-233
                Affiliations
                aDepartment of Angiology, Szent Imre Teaching Hospital, and bDepartment of Cardiology, Istenhegyi Clinic, Budapest, and cDepartment of Cardiology, Markusovszky Hospital, Szombathely, Hungary
                Article
                141927 Kidney Blood Press Res 2008;31:226–233
                10.1159/000141927
                18587241
                cc982bec-c5e3-46f9-a112-189f04439e0c
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 19 September 2007
                : 02 May 2008
                Page count
                Figures: 3, Tables: 4, References: 36, Pages: 8
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                Hypertension,Quinapril,Flow-mediated dilation,Endothelial function,Postmenopausal women

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