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The antiatherogenic effects of antihypertensive treatment: trials completed and ongoing
1Centro di Fisiologia Clinica e Ipertensione, Università di Milano - Ospedale Maggiore, Via F. Sforza 35, 20122 Milano, Italy. zanchett@mailserver.unimi.it
Insights
Carotid intima-media thickness, measured by B-mode ultrasonography, predicts cardiovascular events. Studies show antihypertensive agents like calcium antagonists may benefit hypertensive patients, though more research is ongoing.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Pharmacology
Background:
- Carotid intima-media thickness (CIMT) is a key indicator of atherosclerosis.
- CIMT measurement via B-mode ultrasonography is reliable and predicts cardiovascular events.
- CIMT is correlated with blood pressure, making it a valuable endpoint in intervention trials.
Purpose of the Study:
- To evaluate the role of carotid intima-media thickness as an endpoint in intervention trials.
- To review the efficacy of various antihypertensive agents in reducing CIMT.
- To assess the necessity of including the carotid bifurcation in CIMT measurements.
Main Methods:
- Utilized B-mode ultrasonography for measuring carotid artery wall intima-media thickness.
- Included carotid bifurcation in measurements to improve inferences about atherosclerosis.
- Reviewed completed and ongoing intervention studies using antihypertensive agents.
Main Results:
- Placebo-controlled studies indicated benefits from calcium antagonists and beta-blockers.
- Angiotensin converting enzyme inhibitors showed contradictory responses in non-hypertensive patients.
- In hypertensive patients, some evidence suggests calcium antagonists are more effective than diuretics.
Conclusions:
- Carotid intima-media thickness is a valid surrogate endpoint for cardiovascular risk.
- Antihypertensive interventions, particularly calcium antagonists, show promise in managing atherosclerosis.
- Further research, including ongoing trials, is needed to fully elucidate the effects of different antihypertensive agents in hypertensive populations.
Abstract:
B-mode ultrasonography provides a reliable means of measuring carotid artery wall intima-media thickness. Because carotid intima-media thickness is correlated with blood pressure and is predictive of future cardiovascular events, it can be used as an endpoint in intervention trials. Inclusion of carotid bifurcation in the measurements appears necessary for inferences about atherosclerosis. Several intervention studies using antihypertensive agents have been completed and others are ongoing. Placebo-controlled studies have shown beneficial effects of calcium antagonists and beta-blockers, and contradictory responses with angiotensin converting enzyme inhibitors, but none of these studies have been performed in hypertensive patients. In hypertensive patients, three studies comparing different antihypertensive agents have been completed, with some evidence favoring calcium antagonists over diuretics. Two studies are ongoing, and should be completed and published soon.