Efficacy of Coreg CR and Lisinopril on Markers for Cardiovascular Functional and Structural Disease

- This study will compare the effect of Coreg CR and lisinopril, separately and together,
on Rasmussen Disease Score in a controlled study with an inactive substance (placebo).

- Study patients will have pre-hypertensive (slightly elevated) blood pressures not
requiring therapy.

- Lisinopril is an angiotensin converting enzyme (ACE) inhibitor. Angiotensin is a
chemical that is made by the body continuously. Angiotensin narrows blood vessels and
thereby maintains (elevates) blood pressure. When the enzyme is blocked by lisinopril,
angiotensin cannot be converted into its active form. As a result, blood pressure is
lowered. Lisinopril is a drug that has been approved for use by the U.S. Food and Drug
Administration (FDA) and health authorities for the treatment of high blood pressure and
heart failure.

- Coreg CR is a once-a-day heart medication that is part of a class of drugs known as
beta-blockers. Beta-blockers prevent beta-adrenergic substances such as adrenaline from
activating parts of the nervous system, including the heart. Beta-blockers therefore
relieve stress on the heart by slowing heart beat, decreasing the force of heart muscle
contractions, and reducing blood pressure. Coreg has also been approved by the FDA for
the treatment of hypertension and various other cardiovascular conditions.

- It is possible that the beta blocker could increase the benefits of the ACE inhibitor by
inhibiting renin production, which is an important step in angiotensin production. These
two drugs may act together to provide even more protection to blood vessels and the
heart.

Inclusion Criteria:

- Males and females > 18 years old with pre-hypertensive or borderline blood pressures
(systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg) deemed not
to need antihypertensive therapy. Subjects must also have one additional risk factor
for cardiovascular disease, including:

- LDL > 130 and < 160 mg/dL

- HDL < 40 mg/dL

- Fasting blood sugar >100 and < 126 mg/dL

- Body mass index ≥ 30

- Smoker

- Family history of premature heart disease or hypertension

Exclusion Criteria:

- Patients with a history of cardiac, cerebral or other vascular events within the
previous 6 months will be excluded. Other exclusions include background therapy with a
beta blocker or ACE inhibitor therapy, known or suspected intolerance to beta blockers
or ACE inhibitors, angiotensin receptor blocker therapy, or diabetes. Pregnant or
lactating women, and women of child-bearing age who are not using an acceptable form
of contraception are also excluded from this study.