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Intermediate endpoints for atherosclerosis in hypertension

A Zanchetti1

  • 1Istituto di Clinica Medica, University of Milan, Ospedale Maggiore, Italy.

Blood Pressure. Supplement
|January 1, 1997
PubMed
Summary

Antihypertensive therapy trials need to measure atherosclerosis progression using carotid intima-media thickness (IMT). This non-invasive ultrasound method helps assess plaque growth in hypertensive patients, offering valuable clinical insights.

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Area of Science:

  • Cardiovascular Medicine
  • Hypertension Research
  • Diagnostic Imaging

Background:

  • Event-based trials demonstrate antihypertensive therapy benefits for cardiovascular morbidity and mortality.
  • However, these trials do not assess the impact of antihypertensive therapy on atherosclerosis development.
  • Trials utilizing plaque growth as endpoints are necessary to address this gap.

Purpose of the Study:

  • To evaluate the utility of carotid intima-media thickness (IMT) as an endpoint in trials assessing antihypertensive therapy.
  • To explore the role of non-invasive ultrasound in monitoring atherosclerosis progression in hypertensive individuals.

Main Methods:

  • Quantitative coronary arteriography is unsuitable for uncomplicated hypertensive patients.
  • B-mode quantitative ultrasound assessment of carotid artery intima-media thickness (IMT) is a non-invasive and reproducible method.
  • Current limitations include uncertainty in normality limits, plaque definition, and IMT growth rates in hypertension.

Main Results:

  • Carotid wall lesions are highly prevalent in hypertension, with prevalence dependent on lesion definition criteria.
  • Elevated systolic blood pressure is a significant risk factor for carotid lesions.
  • Increased carotid IMT correlates with a history of coronary or cerebrovascular disease.

Conclusions:

  • Trials of antihypertensive therapy using IMT as an endpoint are likely to yield clinically useful information.
  • Non-invasive ultrasound assessment of IMT offers a promising approach to study atherosclerosis progression in hypertension.
  • Further research is needed to refine IMT measurement standards and interpretation in hypertensive populations.

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