Angiotensin converting enzyme inhibition improves endothelial dysfunction in chronic cigarette smokers

R. Butler*, A. D. Morris, A. D. Struthers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


ACE inhibitors have been shown to improve mortality in heart failure, left ventricular dysfunction and endothelial dysfunction in coronary artery disease, diabetes and in hyperlipidaemia. Cigarette smoking causes endothelial dysfunction, it now seems appropriate to examine whether ACE inhibitors improve endothelial function in smokers. We treated 23 subjects (mean age 38±12 years) for eight weeks with 20 mg of lisinopril in a randomised, placebo controlled, double blind, cross over study. Endothelial function was assessed by venous occlusion plethysmography using intra-arterial infusions of endothelial-dependent (acetylcholine) and independent (sodium nitroprusside) vasodilators and endothelial-dependent (L-NMMA) vasoconstrictor. Forearm vascular response: Lisinopril significantly increased the forearm blood flow response to acetylcholine (3.12±1.76 vs. 2.58±1.21 ml/100mls/min lisinopril vs. placebo; p=0.02, 95% CI 0.09, 1.06); there was no difference in the response to sodium nitroprusside (3.97±1.87 vs. 3.92±1.85 ml/100mls/min lisinopril vs. placebo; p=0.84, 95% CI -0.50, 0.61). The vasoconstrictor response demonstrated a significant improvement to monomethyl-L-arginine (L-NMMA) (0.77±0.27 vs. 0.95±0.19 ml/100mls/min lisinopril vs. placebo; p<0.001, 95% CI -0.09.-0.27). Mean arterial pressure fell with lisinopril, 86±14 vs. 97±10 mmHg (lisinopril vs. placebo; p=0.006). These results indicate for the first time that ACE inhibition improves endothelial dysfunction in cigarette smokers. Lisinopril may cause less ang II induced superoxide radicals which can inactivate NO or because of changes in bradykinin metabolism. ACE inhibitors may have beneficial anti-atherosclerotic effects in at risk patients with endothelial dysfunction who are unable, or unwilling, to stop cigarette smoking.

Original languageEnglish
Issue numberSUPPL. 1
Publication statusPublished - 1 May 1999


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