The Effects of Combination Therapy of Felodipine and Ramipril on Plaque Regression and Plaque Compositional Changes in Patients with Hypertension and Angina with Mild to Moderate Degree of Coronary Stenosis

Hong, Young Joon; Jeong, Myung Ho; Choi, Yun Ha; Ma, Eun Hae; Ko, Jum Suk; Lee, Min Goo; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUND
Calcium channel blockers (CCB) and angiotensin converting enzyme (ACE) inhibitors can block the development of atherosclerosis. Fixed-dose combinations of a CCB, felodipine, and an ACE inhibitor, ramipril, are more effective at controlling hypertension than monotherapy. We used serial virtual histology and intravascular ultrasound (VH-IVUS) to assess the efficacy of combined felodipine + ramipril therapy on regression and compositional changes of plaque in patients with hypertension and angina with a mild to moderate degree of coronary stenosis. Comparisons were made to monotherapies.
METHODS
This study was a prospective, comparative study using (1) felodipine 5 mg/ramipril 5 mg vs. (2) felodipine 10 mg and ramipril 10 mg. A total of 68 lesions in 68 patients were analyzed and the three drug groups [felodipine group (n=25) vs. ramipril group (n=21) vs. felodipine/ramipril group (n=22) compared. VH-IVUS was done during baseline coronary angiography and repeated after 9-month of treatment.
RESULTS
Nine months after the baseline IVUS examination, systolic and diastolic blood pressures decreased significantly in all three groups. There was no significant difference in changes in percent atheroma volume from baseline to follow-up comparing the three groups (pre- and post- scores for the felodipine, ramipril, and combination groups were, respectively, 49+/-6 to 48+/-6%, 47+/-5 to 46+/-5%, and 51+/-5 to 51+/-5%, p=0.908). There was no significant difference in change scores for plaque components from baseline to follow-up comparing the three groups. Change scores for the felodipine, ramipril, and combination groups, were, respectively, +2.5+/-9.2% vs. +1.3+/-11.6%, and 2.6+/-9.7% (p=0.224). Fibro-fatty change scores were -4.9+/-10.8%, -4.6+/-10.1% and -2.1+/-4.9%, (p=0.518). Calcium density change scores were +1.6+/-6.0%, +1.2+/-7.3% and +2.1+/-4.2%, (p=0.884). Necrotic core change scores were: +0.6+/-9.2%, +2.1+/-10.4% and +2.5+/-9.2%, (p=0.789).
CONCLUSION
Combination therapy with felodipine and ramipril has no advantage over monotherapy for treating plaque regression and plaque compositional changes in patients with hypertension and angina with a mild to moderate degree of coronary stenosis.