[The therapeutic possibilities of the regression of the vascular changes in hypertension]

Arterial hypertension has an important functional and morphological influence on the arterial system. The evaluation of functional and morphological changes is based upon such terms as compliance, stiffness, distensibility in the former and intima-media thickness (IMT), number and kind of atheromatous plaques in the latter case. Functional changes in the large arteries can be modified by antihypertensive and hypolipemic agents. The IMT as a non-invasive marker of vascular wall injury is increasingly frequently used in the studies. It has been identified as a significant predictor of coronary and cerebral vascular complications. Most studies on hypolipemic therapy demonstrate that the progression of IMT is slowed down. Ca-antagonists, ACE inhibitors and beta blockers are the most frequently studied agents with respect to their influence on IMT in the following patient populations: hypertensives, patients with coronary artery disease, at high cardiovascular risk and asymptomatic subjects with carotid plaque. The present paper summarises the results of these studies. The findings of the ELSA trial, the largest study evaluating the effects of therapy on IMT are noteworthy. It has been demonstrated that lacidipine has a better antiatheromatous effect than atenolol, which is independent of its hypotensive properties. Non-invasive, relatively easy ultrasound measurement of IMT in the carotid artery is an important tool to detect atheromatous lesions and because of its prognostic value. It may also serve as a predictor of cardiovascular complications, which helps in the process of therapeutic decision-making.