Angiotensin-converting enzyme inhibitors proved to be effective in the primary and
secondary prevention of
cardiovascular diseases. Clinical effectiveness of this group of agents may largely depend on their pleiotropic effects. The purpose of this study was to compare the effects of plasma- and tissue-type
angiotensin-converting enzyme inhibitors on blood pressure and on systemic
inflammation, hemostasis and oxidative functions in normotensive patients with stable
coronary artery disease. Ninety patients with stable
coronary artery disease enrolled into the study were randomly divided into three different groups, simultaneously treated with
enalapril (20 mg/d,
n = 30),
perindopril (4 mg/d,
n = 30) or placebo (
n = 30). Plasma
lipid profile and the levels of oxidized
low density lipoproteins (LDLs),
monocyte chemoattractant protein (MCP)-1,
interleukin-10,
C-reactive protein (CRP),
fibrinogen and
plasminogen activator inhibitor (PAI)-1 were determined at the beginning of the study and after 30 and 90 days of treatment. Seventy-six patients completed the trial. Neither
enalapril nor
perindopril affected blood pressure or plasma
lipids.
Perindopril significantly reduced plasma levels of oxidized LDLs, CRP, MCP-1,
fibrinogen and
PAI-1, and increased
interleukin-10. The effect of
enalapril on these markers of systemic
inflammation, hemostasis and oxidative functions was much less pronounced. The results showed that
enalapril and
perindopril were devoid of a blood pressure-lowering effect in normotensive patients with stable
coronary artery disease.
Perindopril was superior to
enalapril in exhibiting
antioxidant, antithrombotic and profibrinolytic activities. The treatment-induced changes in the balance between pro- and antiinflammatory
cytokines and in hemostasis may contribute to the clinical effectiveness of tissue
angiotensin-converting enzyme inhibitors in the
therapy of
atherosclerosis-related disorders.