MIDAS, the Multicenter Isradipine/Diuretic Atherosclerosis Study. Design features and baseline data

Area of Science:

• Cardiology
• Pharmacology
• Vascular Medicine

Background:

• Hypertension is a major risk factor for atherosclerosis.
• Controlling blood pressure is crucial for preventing cardiovascular events.
• Early detection and management of carotid artery atherosclerosis are important.

Purpose of the Study:

• To compare the effectiveness of isradipine and hydrochlorothiazide in managing hypertension.
• To evaluate the impact of these antihypertensive treatments on the progression of early extracranial carotid artery atherosclerosis.
• To assess the role of enalapril as an add-on therapy for uncontrolled hypertension.

Main Methods:

• Randomized, double-blind, active-control trial (MIDAS study) involving 883 hypertensive patients.
• Treatment regimens included isradipine (2.5-5 mg BID) or hydrochlorothiazide (12.5-25 mg BID).
• Patients with uncontrolled blood pressure received open-label enalapril (2.5-10 mg BID).
• Inclusion criteria: age >40, carotid atherosclerosis (1.3-3.5 mm thickness), diastolic BP 90-115 mm Hg, LDL 130-189 mg/dL.
• Monitoring included blood pressure, side effects, B-mode ultrasound of carotid arteries, ECG, and quality-of-life assessments.

Main Results:

• The study enrolled 883 patients to evaluate isradipine versus hydrochlorothiazide.
• Regular monitoring of blood pressure, atherosclerosis progression via ultrasound, ECG, and quality of life was conducted.
• Add-on therapy with enalapril was used for patients with uncontrolled hypertension.

Conclusions:

• The MIDAS study provides data on the comparative effectiveness of isradipine and hydrochlorothiazide in hypertensive patients.
• It investigates the influence of these treatments on carotid artery atherosclerosis progression.
• Findings contribute to understanding hypertension management strategies for cardiovascular risk reduction.