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Carotid artery hemodynamics: observing patient-specific changes with amlodipine and lisinopril by using MR imaging computation fluid dynamics.

Author(s): Ariff BB, Glor FP, Crowe L, Xu XY, Vennart W, Firmin DN, Thom SM, Hughes AD

Affiliation(s): International Centre for Circulatory Health, National Heart and Lung Institute Division, Faculty of Medicine, Imperial College London, and Imperial College Healthcare National Health Service Trust, London, England. b.ariff@imperial.ac.uk

Publication date & source: 2010-12, Radiology., 257(3):662-9. Epub 2010 Oct 8.

Publication type: Randomized Controlled Trial; Research Support, Non-U.S. Gov't

PURPOSE: To assess whether using magnetic resonance (MR) imaging combined with computational fluid dynamics (CFD) could reveal changes in common carotid artery (CCA) flow and wall shear stress (WSS) that might contribute to differences in CCA remodeling between amlodipine, a calcium channel blocker, and lisinopril, an angiotensin-converting enzyme inhibitor, despite similar reductions in blood pressure (BP). MATERIALS AND METHODS: Institutional review board approval was obtained, and participants gave informed consent. Nine subjects with hypertension were recruited into a double-blind placebo-controlled randomized three-way crossover study to compare the hemodynamic effects of 7 days of treatment with placebo, amlodipine, or lisinopril. After each treatment period, patients underwent CCA ultrasonography, BP measurement, and MR imaging with CFD. Analyses were performed by using repeated-measures analysis of variance, followed by the Tukey test or the Wilcoxon matched-pairs test. RESULTS: Amlodipine and lisinopril lowered BP similarly, but CCA flow rate was significantly higher (P < .01) and distal vascular resistance was lower (P = .016) after amlodipine treatment than after lisinopril treatment. WSS on the inner wall of the CCA was significantly lower after lisinopril treatment than after amlodipine treatment (P = .03). The change in WSS in the CCA correlated with the change in vascular resistance (r = -0.85, P < .001). CONCLUSION: Amlodipine causes increased blood flow and increased time-averaged WSS in the CCA compared with lisinopril, despite similar reductions in BP. Differences in the subacute hemodynamic effects of amlodipine and lisinopril could contribute to the differences in CCA remodeling seen in long-term studies. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100788/-/DC1. (c) RSNA, 2010

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