Abstract P213: Angiotensin Converting Enzyme Inhibitors (ACEi) Increase Antifibrotic Biomarkers in African American Patients With Hypertension and Left Ventricular Hypertrophy

Abstract

ACEi are first line treatment in hypertension; however, there is controversy regarding the benefit over other antihypertensive drugs. ACEi have pressure independent effects that may make them preferable for certain patients. We aimed to evaluate the impact of ACEi on antifibrotic biomarkers in hypertensive patients with left ventricular hypertrophy (LVH). We conducted a post hoc analysis of a randomized controlled trial where hypertensive African American patients with LVH and vitamin D (VTD) deficiency were randomized to receive standard antihypertensive therapy plus VTD supplementation or placebo. We selected patients who had detectable lisinopril in plasma at one year follow-up and compared them to subjects who did not. The profibrotic marker propeptide of procollagen type I (CPIP) and the antifibrotic markers: matrix metalloproteinase-1 (MMP-1), tissue inhibitor of MMP1 (TIMP-1), the MMP-1/TIMP-1 ratio, telopeptide of collagen type I (CITP) and Ac-SDKP peptide were measured. Sixty six patients were included. Table 1 shows patients characteristics. Patients with lisinopril had lower blood pressure at one-year but no differences were observed in left ventricular mass index (LVMI). The antifibrotic markers Ac-SDKP (3.9±2.6 vs 6.3±2.8; p<0.001), MMP1 and MMP1/TIMP-1 ratio were higher in patients with detectable ACEi (all p<0.05). In a model adjusted for systolic blood pressure, low LVMI (p=0.01), MMP1/TIMP-1 (p=0.02) and Ac-SDKP (p<0.001) levels were associated with lisinopril. We conclude that ACEi increase antifibrotic biomarkers in African Americans with hypertension and LVH, suggesting that they may be offer added benefit over other agents in such patients.

The significance of plasma collagen degradation products as biomarkers for advanced hypertensive heart disease

“…The findings by Romero et. al 5 are consistent with the results from numerous prior studies. It is true that the studied population is once again small, and the concept is not novel.…”

“…In the study published in this issue of the Journal of Clinical Hypertension by Romero et al, 5 the levels of pro‐ and anti‐fibrotic markers in hypertensive African American patients with LVH after one year of intensive treatment with ACE inhibitors vs. other antihypertensive medications are compared. The investigators performed a post hoc analysis of a randomized controlled trial in which hypertensive African American patients with LVH and vitamin D deficiency have been randomized to receive intensive antihypertensive therapy plus vitamin D supplementation or placebo.…”

Promising results of captopril in improving knee arthrofibrosis and cartilage status: an animal model study

“…Angiotensin‐converting enzyme inhibitor (ACEI) decreases the production of angiotensin II, subsequently decreasing the production of IL1, TNF, MMP, TGF, and vascular endothelial growth factor (VEGF). Several studies revealed that ACEI significantly reduces fibrosis formation in some organs, including the liver, heart, and kidneys [3, 28, 31, 33, 38]. Studies suggest that this drug family may affect the renin angiotensin system by inhibiting angiotensin II, stimulating prostaglandin and bradykinin, and showing antioxidant effect through the free radical scavenger action [5].…”