Losartan and perindopril effects on plasma plasminogen activator inhibitor-1 and fibrinogen in hypertensive type 2 diabetic patients

Background: This study compared the effects of losartan and perindopril on plasma plasminogen activator inhibitor-1 (PAI-1) and fibrinogen in hypertensive type 2 diabetic patients. Methods: We studied 85 nonsmoking outpatients, aged 46 to 64 years, with mild to moderate essential hypertension (diastolic blood pressure [BP] >90 and <110 mm Hg) and well controlled type 2 diabetes mellitus. After a 4-week washout placebo period, patients were randomized to received perindopril 4 mg once daily (n = 42) or losartan 50 mg once daily (n = 43) for 12 weeks according to a double-blind, parallel-group design. At the end of the placebo and active treatment periods. BP was measured and plasma PAI- I and fibrinogen were evaluated. Results: Both perindopril and losartan reduced systolic and diastolic BP values (- 16/15 min Hg and - 15114, respectively; P<.001 v placebo). with no difference between the two treatments. Plasma PAI- I was reduced by perindopril (-10 ng/dL, P =.028 v placebo) but not by losartan (+4 ng/dL, NS), the difference between the two treatments being statistically significant (P <.01). Plasma C fibrinogen showed no significant change with both drugs, C although a decreasing trend was noted with perindopril. Conclusions: These findings indicate that perindopril but not losartan decreases PAM in hypertensive type 2 diabetic patients, which suggests that the PAM lowering effect is unrelated with AT, receptor blockade and could rather he due to the fact that the endothelial receptors that mediate PAI-1 expression in response to angiotensin 11 are not type I receptor subtypes. Different effects of the two drugs on the bradykinin system might also be implicated. (C) 2002 American Journal of Hypertension. Ltd.