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Vessel wall properties of large arteries in hypertension and effect of antihypertensive treatment.

Distensibility and compliance are large artery properties that may be important in cardiovascular disease. Distensibility is a determinant of the pulsatile stress on the vessel wall and is thought to be important in atherosclerotic disease. Compliance reflects the buffering capacity of the arteries and is a major determinant of afterload on the heart. In hypertension, large arteries become stiffer, resulting in decreased distensibility and compliance. Decrease in blood pressure can improve large artery properties, but not all antihypertensive drugs improve large artery properties. Compliance is improved by antihypertensive drugs such as angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, beta-blockers with vasodilating properties, selective beta 1-blockers and some diuretics. Recent data suggest that ACE inhibitors like perindopril improve distensibility and compliance of large arteries more than diuretics such as amiloride hydrochlorothiazide do. This makes, apart from the indirect effect--the decrease in blood pressure--a direct effect of perindopril on large artery properties very likely. ACE inhibitors like perindopril decrease the afterload on the heart more than diuretics (such as amiloride hydrochlorothiazide) by both a more pronounced decrease in systemic vascular resistance and increase in large artery compliance.