Effects of ACE Inhibition on Circulating Endothelial Progenitor Cells, Vascular Damage, and Oxidative Stress in Hypertensive Patients

Eur J Clin Pharmacol. 2011 Sep;67(9):877-83. doi: 10.1007/s00228-011-1029-0. Epub 2011 Mar 29.


Purpose: The pathogenic role of angiotensin-converting enzyme (ACE) inhibition in hypertensive patients regarding endothelial progenitor-cell (EPC) function is still poorly understood. The aim of the study was to evaluate EPC number, function, and relationship to carotid intima media thickness (IMT) progression.

Methods: We studied 36 newly diagnosed mildly hypertensive patients free of cardiovascular disease and related risk factors without prior or concurrent therapy with ACE inhibitors. Patients were randomized to receive enalapril 20 mg/day (n = 18) or zofenopril 30 mg/day (n = 18). EPC number and migrating capacity, plasma nitrite and nitrate (NOx), and isoprostane concentrations were evaluated. Carotid IMT was determined by ultrasonography at baseline and after 1 and 5 years of follow-up.

Results: EPC number increased during the follow-up, with no statistical differences between treatment groups. There was an inverse correlation between circulating EPCs and IMT increase over time. Plasma NOx decreased during the study without evident differences between treatment groups. Isoprostanes decreased more markedly in zofenopril-treated patients. Multiple linear regression model demonstrated that carotid IMT was significantly inversely correlated with EPC but not with migratory cells after adjusting for confounders.

Conclusions: The study demonstrated that EPC levels increased during the follow-up in both groups of newly diagnosed hypertensive patients treated with ACE inhibitors. These drugs prevented progression of vascular damage, with an inverse correlation between circulating EPC levels and IMT values.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Captopril / administration & dosage
  • Captopril / analogs & derivatives*
  • Captopril / therapeutic use
  • Carotid Arteries / diagnostic imaging
  • Carotid Arteries / pathology*
  • Cell Count
  • Cell Movement / drug effects*
  • Cells, Cultured
  • Enalapril / administration & dosage
  • Enalapril / therapeutic use*
  • Endothelial Cells / cytology
  • Endothelial Cells / drug effects
  • Follow-Up Studies
  • Humans
  • Hypertension / blood
  • Hypertension / drug therapy*
  • Hypertension / pathology
  • Isoprostanes / blood
  • Middle Aged
  • Nitrates / blood
  • Nitrites / blood
  • Regression Analysis
  • Stem Cells / cytology
  • Stem Cells / drug effects
  • Treatment Outcome
  • Tunica Intima / diagnostic imaging
  • Tunica Intima / pathology
  • Ultrasonography


  • Angiotensin-Converting Enzyme Inhibitors
  • Isoprostanes
  • Nitrates
  • Nitrites
  • zofenopril
  • Enalapril
  • Captopril