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[Effects of antihypertensive treatment on carotid vascular changes]
F Pompeo1, N De Luca, R Marchegiano
1I Clinica Medica, Università degli Studi di Napoli Federico II.
Insights
This study shows that lacidipine, a calcium antagonist, improved carotid blood flow and arterial compliance in hypertensive patients. Unlike hydrochlorothiazide, lacidipine treatment positively influenced carotid vascular abnormalities.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Vascular Biology
Background:
- Atherosclerosis, a major cause of cardiovascular disease, often affects the carotid artery.
- Arterial hypertension is a key risk factor for atherosclerosis progression.
- Antihypertensive treatments can benefit atherosclerosis management, with some agents directly impacting lesions.
Purpose of the Study:
- To evaluate the long-term efficacy of blood pressure reduction on cardiovascular structural abnormalities.
- To compare the effects of lacidipine (a calcium antagonist) and hydrochlorothiazide (a diuretic) on intima-media thickness and arterial compliance.
- To assess the impact of antihypertensive treatment on carotid artery health.
Main Methods:
- One-year randomized controlled trial involving hypertensive patients.
- Treatment groups received either lacidipine or hydrochlorothiazide.
- Measurements included blood pressure, intima-media thickness, arterial compliance, and carotid blood flow using non-invasive techniques like B-mode ultrasound and pulsed-Doppler.
Main Results:
- Both lacidipine and hydrochlorothiazide achieved comparable blood pressure reduction.
- Lacidipine treatment led to significant improvements in carotid blood flow and arterial compliance.
- Intima-media thickness showed different trends between the two groups, with a trend towards increase in the hydrochlorothiazide group.
Conclusions:
- Effective antihypertensive treatment with calcium antagonists like lacidipine can positively influence carotid vascular abnormalities.
- Lacidipine demonstrates superior effects on vascular function (blood flow and compliance) compared to hydrochlorothiazide in hypertensive patients.
- Non-invasive diagnostic techniques are valuable for early detection and monitoring of atherosclerosis progression.
Abstract:
The carotid artery is one of the most important sites in the progression of atherosclerotic lesions. Atherosclerosis is known to be determined by a variety of factors, among which arterial hypertension is one of the most important. Blood pressure control by antihypertensive treatment is thus of great benefit in management of atherosclerosis, particularly in view of the direct action of some classes of antihypertensive agents on atheromatous lesions. Today, modern diagnostic technique allow a non-invasive examination of the artery wall (B-mode ultrasound and pulsed-Doppler), so that early detection of structural and functional alterations is possible. In order to evaluate the efficacy of the long term blood pressure reduction in the progression and/or in the regression of cardiovascular structural abnormalities, we studied intima-media thickness and arterial compliance during one-year antihypertensive treatment with a new calcium-antagonist, lacidipine, or a diuretic hydrochlorothiazide. In both groups we observed a comparable blood pressure reduction (lacidipine: from 166 +/- 5/100 +/- 1 to 142 +/- 4/88 +/- 2 mmHg; hydrochlorothiazide: from 154 +/- 5/102 +/- 2 to 140 +/- 4/88 +/- mmHg; both p < 0.01). On the contrary, only in patients treated with lacidipine did we obtain a significant improvement in carotid blood flow (383 +/- 16 vs 411 +/- 16 ml/min p <) and in arterial compliance (0.8 +/- 0.1 vs 1.2 +/- 0.2 cm/dyne p < 0.01). Indeed, we observed a different behaviour of the intima-media thickness in the two groups (lacidipine: 1.11 +/- 1.4 vs 1.13 +/- 1.5 mm n.s.; hydrochlorothiazide: 1.15 +/- 0.15 vs 1.21 +/- 0.17 mm p < 0.06). Our results demonstrate that an effective antihypertensive treatment with calcium antagonists may influence the progression of carotid vascular abnormalities.