Efecto de moexipril en el índice brazo-tobillo en pacientes hipertensos

Background: Ankle-braquial index (ABI) is an useful tool for the diagnosis of peripheral arterial disease, but it is also an independent and positive predictor of endothelial dysfunction and cardiovascular risk. In the INDAGA study, 76% of the patients with an ABI < 0.9 were hypertensive. Inhibitors of the renin angiotensin system ameliorate vascular function and must improve the ABI. Objective: To study if the management of arterial hypertension with inhibitors of the angiotensin converting enzyme (ACEI) improves the ABI. Material and method: A study in which 30 hypertensive patients never treated with ACEI nor with antagonist of the angiotensin receptor were evaluated. Patients were treated with moexipril 7.5 mg/day, the dose was titrated to 15 mg if blood pressure values <140/90 mmHg were not reached. In all patients the ABI was registered with a 5 megahertz doppler (Summit doppler L250, Life Dop., USA) at the beginning and the end of the study 3 months later, an ABI between 0.9 and 1.3 was considered normal. Statistical analysis was performed with the Wilcoxon test. Results: In all patients a good control of blood pressure values was obtained (166/96 to 129/77 mmHg, p< 0.01), although 15 patients required increasing the dose. The ABI was modified from 0.93 to 1.03 (p<0.01), in 11 patients the management normalized the ABI above 0.9. A regression analysis showed that the improvement in the ABI was independent of the blood pressure control. Conclusion: Treating hypertension with moexipril ameliorates the ABI in hypertensive patients independently from its antihypertensive effect and explains the effect of ACEI in the improvement of cardiovascular prognosis.