Effect of perindopril on vasoreactivity in patients with hypertensive chronic cerebrovascular disease. A comparative analysis of different brain structures.

Background And Purpose: The angiotensin-converting enzyme inhibitor perindopril (CAS 107133-36-8) helps to prevent stroke recurrence by improving cerebral vasomotor reactivity (CVR). Perindopril-induced vasoreactivity changes in different brain structures of patients with chronic cerebrovascular disease were compared.

Methods: The study population consisted of 6 hypertensive patients (mean age 65.5 +/- 9.9) who had experienced a cerebrovascular event; three each had minor ischemic episodes and hemorrhage. The administration of 4 mg/day perindopril was started one month after stroke onset; the follow-up lasted more than one year. Their cerebral blood flow (CBF), assessed at the start of perindopril administration and again 3 months later, was examined both at rest and after the administration of 15 mg/kg acetazolamide and the CVR was calculated. Regions of interest were cortical and subcortical areas on the CT scans.

Results: In the course of this study, none of the patients suffered stroke recurrence. The 3-month administration of perindopril lowered their systemic blood pressure without decreasing CBF and significantly increased cerebral vasoreactivity in the lesioned (p = 0.04355) and contralateral (p = 0.04090) cortical areas without producing significant changes in CVR in the subcortical gray matter (striatum and thalamus).

Conclusion: The CVR in cortical structures recovered sooner than that in subcortical gray matter. Although the number of stroke patients included in this study was small, it is concluded that this phenomenon may be attributable to the earlier vasoreactivity increase in the cortical vessels than the subcortical perforators.