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[The preliminary clinical evidence from the ELSA study. The European Lacidipine Study on Atherosclerosis]
1Università degli Studi di Milano.
Insights
Mild to moderate hypertension significantly impacts carotid arteries, with most patients showing plaques or intima-media thickening. This highlights the need for proactive management even without other risk factors.
Area of Science:
- Cardiology
- Vascular Medicine
- Hypertension Research
Background:
- Cardiovascular complications in hypertension are traditionally assessed by event incidence (e.g., myocardial infarction, stroke).
- Arterial hypertension is a primary driver of atherosclerotic disease, not solely cardiovascular events.
- Quantitative ultrasonography offers a non-invasive, cost-effective alternative to arteriography for assessing vascular changes.
Purpose of the Study:
- To evaluate the effects of antihypertensive agents on carotid artery modifications in hypertensive patients.
- To compare the impact of lacidipine (calcium-antagonist) and atenolol (beta-blocker) on carotid changes and cardiovascular events.
- To assess blood pressure and carotid vessel modifications over a 4-year follow-up in mild to moderate hypertension.
Main Methods:
- The European Lacidipine Study on Atherosclerosis (ELSA) enrolled patients with mild to moderate hypertension.
- Quantitative ultrasonography was employed to assess carotid vessel modifications.
- Demographic data and carotid characteristics of the first 1000 randomized patients were analyzed.
Main Results:
- Preliminary analysis of 1000 patients revealed significant carotid atherosclerosis.
- 84% of patients exhibited carotid plaques.
- 15% showed intima-media thickening, and only 1% had normal vessels.
Conclusions:
- A high prevalence of carotid atherosclerosis exists in patients with mild to moderate hypertension, even without other risk factors.
- These findings underscore the importance of recognizing and managing hypertension early to prevent vascular disease progression.
- Physicians should not overlook patients with mild to moderate hypertension due to the high incidence of underlying atherosclerotic changes.
Abstract:
Up to the present the relationship between arterial hypertension or its treatment and cardiovascular complications has been evaluated in terms of the incidence of events, such as fatal and nonfatal myocardial infarction or stroke and cardiac deaths. However, cardiovascular events are not the direct consequence of blood pressure elevation, which, on the contrary, is responsible for atherosclerotic disease. Quantitative ultrasonography is a sensitive, specific and reproducible technique which, in comparison to arteriography, is non invasive and less expensive. The availability of this technique has allowed us to do some studies, one just published, another in the elaboration phase and others ongoing, aimed at evaluating the effects of antihypertensive agents on carotid changes in hypertensive patients. The European Lacidipine Study on Atherosclerosis (ELSA) compares the effects of lacidipine, a calcium-antagonist and of atenolol, a beta-blocker, on blood pressure, on carotid vessel modifications, and on the incidence of cardiovascular events in patients with mild to moderate hypertension with a 4-year follow-up period. Preliminary results of the study, which were concerned with the demographic characteristics of the first 1000 randomized patients enrolled, indicate that 84% of the patients had a carotid plaque, 15% had thickening of the intima-media, and 1% had a normal vessel. These results are both surprising and significant in that they admonish the physician not to neglect patients with mild to moderate hypertension even when they have neither complications nor other risk factors.