P.008 The Effect of Ramipril and Valsartan on Aortic Stiffness and Wave Reflections in Patients with Successful Coarctation Repair

Abstract

Introduction

Patients after successful coarctation repair (SCR) have increased incidence of cardiovascular complications due to relapse of hypertension, which is mainly attributed to impaired elastic properties of the upper body arteries. Angiotensin converting enzyme inhibitors and angiotensin receptor antagonists reduce aortic stiffness and wave reflections; however their effect on arterial stiffness in postcoarctectomy patients has not been studied yet.

Methods

12 patients, 25±6 years with SCR at 14±7 years, normotensive at rest, were studied at 4 different occasions with a randomised, cross-over design: (i) at baseline and 4 weeks after ramipril 5 mg/day; (ii) at baseline and 4 weeks after valsartan 160 mg/day. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness with Complior^®. Augmentation index (AIx) was measured as an index of wave reflections using SphygmoCor^®.

Results

Both ramipril and valsartan decreased peripheral blood pressure (systolic by 7.6±9 and 5.9±7 mmHg respectively, P < 0.05 for both, diastolic by 6.5±5 and 9.1±6 mmHg respectively, P <0.01 for both). PWV and AIx were also decreased with ramipril and valsartan (PWV by 0.5±0.3 and 0.6±0.6 m/s, P < 0.005 and <0.01 respectively; AIx by 5.2±4 and 5.8±4 respectively, P < 0.005 for both). When the effect of ramipril on systolic and diastolic pressure, PWV, and AIx was compared to that of valsartan, no difference was observed in any parameter.

Conclusions

Ramipril reduce aortic stiffness and wave reflections to the same degree as valsartan in patients after SCR. Their beneficial effects should be taken into account when treatment in SCR patients is considered.