Effets cardioprotecteurs des antihypertenseurs

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Abstract
Meta-analyses of clinical trials of antihypertensive medications which have measured regression of left ventricular hypertrophy reveal differences between classes of agent, with ACE inhibitors, angiotensin receptor blockers (ARBs), and calcium antagonists being more effective than beta-blockers. The PICXEL study showed that a strategy based on a low-dose combination of the ACE inhibitor perindopril and the diuretic indapamide was significantly more effective than the ACE inhibitor enalapril alone in reducing left ventricular mass. The cardioprotective effect of the combination appears to be independent of its blood pressure lowering effect. A pilot study in patients has shown that perindopril/indapamide improves coronary perfusion which is reduced in hypertension, especially in patients with left ventricular hypertrophy. In a separate study perindopril/indapamide has shown a trend towards reducing cardiovascular events. Animal studies suggest that the combination reverses the changes in arteriolar and capillary densities associated with hypertension. Clinical and experimental studies of the cardioprotective actions of antihypertensive agents are providing a better understanding of how cardiovascular complications in hypertension can be reduced by careful choice of antihypertensive medication.