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Diabetes and Vascular Disease Research
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Divergent effects of angiotensin-converting enzyme inhibition on blood pressure and endothelial function in obese humans

Ian L Williams

GKT School of Medicine, King's College, London, SE5 9PJ, UK

Philip J Chowienczyk

GKT School of Medicine, King's College, London, SE5 9PJ, UK

Stephen B Wheatcroft

GKT School of Medicine, King's College, London, SE5 9PJ, UK

Ameet G Patel

Department of Surgery, King's College Hospital, London, UK

Roy A Sherwood

GKT School of Medicine, King's College, London, SE5 9PJ, UK

Ajay M Shah

GKT School of Medicine, King's College, London, SE5 9PJ, UK

Mark T Kearney

GKT School of Medicine, King's College, London, SE5 9PJ, UK

Endothelial dysfunction is a pivotal early event in the development of atherosclerosis and a characteristic feature of obesity. This study was designed to investigate the effect of angiotensin-converting enzyme (ACE) inhibition on endothelial function in people who were obese but otherwise healthy. We performed a double-blind, randomised, placebo-controlled study examining the effect of the ACE inhibitor perindopril (4 mg per day) on flow-mediated vasodilatation (FMD) of the brachial artery, arterial blood pressure, glucose homeostasis and inflammatory cytokines. Eighteen obese subjects (all body mass index > 30 kg/m2) were randomised to receive perindopril or placebo for four weeks. Perindopril led to a fall in systolic blood pressure from 131 (standard error of mean [SEM] 3) to 117(5) mmHg and diastolic blood pressure from 74(4) mmHg to 68(4) mmHg, both p<0.001. Despite this fall in blood pressure, ACE inhibition had no effect on FMD, 8.2 (1.2)% versus 8.3 (1.5)%, p=0.9. ACE inhibition had no effect on insulin, lipids or circulating cytokines. In healthy obese humans, despite a significant reduction in blood pressure, ACE inhibition had no effect on FMD.

Key Words: obesity • endothelial function • renin-angiotensin system

Diabetes and Vascular Disease Research, Vol. 3, No. 1, 34-38 (2006)
DOI: 10.3132/dvdr.2006.004
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