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(Stroke. 2004;35:2117.)
© 2004 American Heart Association, Inc.

Original Contributions

Long-Term Angiotensin-Converting Enzyme Inhibitor Perindopril Therapy Improves Cerebral Perfusion Reserve in Patients With Previous Minor Stroke

Jun Hatazawa, MD, PhD; Eku Shimosegawa, MD, PhD; Yasuhiro Osaki, MD; Masanobu Ibaraki, DSc; Naohiko Oku, MD, PhD; Shinji Hasegawa, MD, PhD; Ken Nagata, MD, PhD; Yutaka Hirata, MD Yuko Miura, BSc

From the Departments of Radiology and Nuclear Medicine (J.H., E.S., M.I., Y.M.) and Neurology (K.N., Y.H.), Research Institute of Brain and Blood Vessels, Akita, Japan; and the Department of Nuclear Medicine and Tracer Kinetics (J.H., Y.O., N.O., S.H.), Osaka University Graduate School of Medicine, Osaka, Japan.

Correspondence to Dr Jun Hatazawa, Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan. E-mail hatazawa{at}tracer.med.osaka-u.ac.jp

Background and Purpose— Angiotensin-converting enzyme (ACE) inhibitor-based therapy reduces the recurrence of stroke. The present study assessed the effects of long-term ACE inhibitor therapy on cerebral circulation in patients with previous minor stroke.

Methods— After a run-in period, 19 patients were randomized to ACE inhibitor therapy (n=9; 4 mg of perindopril daily; mean age, 64±8 years; mean systolic/diastolic blood pressure [BP]±SD, 133±12/77±9 mm Hg) or placebo therapy (n=10; mean age, 66±9 years; mean BP, 139±10/78±8 mm Hg). Cerebral blood flow (CBF) was measured during hypercapnia, normocapnia, and hypocapnia using a positron emission tomography with H₂¹⁵O at entry into the study and after 3 to 12 months. Cerebral perfusion reserve (CPR) was defined as percent CBF response to a 1 mm Hg change in arterial partial pressure of CO₂ between hypercapnia and hypocapnia.

Results— Systolic/diastolic BP and CBF during normocapnia showed no significant changes between entry and completion of the trial in the perindopril and placebo groups. Mean value of CPR showed a significant increase in the perindopril group (from 3.7±1.7%/mm Hg to 4.8±1.7%/mm Hg; P<0.05) but not in the placebo group (from 4.1±0.8%/mm Hg to 4.2±0.6%/mm Hg; NS). Statistical parametric mapping analysis also showed global and significant increase (P<0.01, uncorrected) in CPR in the perindopril group alone.

Conclusions— Long-term ACE inhibitor-based therapy had a beneficial effect on the cerebral circulation by improving CPR in patients with previous minor stroke.

Key Words: angiotensin-converting enzyme inhibitors • cerebral blood flow • hypertension • perfusion • tomography, emission-computed