Carotid artery wall alterations as intermediate end points.
Carotid artery wall alterations can now be measured in a quantitative, well reproducible way by B-mode ultrasound. The thickness of the intima-media complex (IMT) is commonly measured at three levels along the carotid tree. Well standardized protocols to use in randomized prospective trials are available. It is argued that IMT measurements can be used as intermediate end points of antihypertensive treatment trials as 1) IMT alterations are frequent in hypertension and closely correlated to systolic and pulse pressures; 2) IMT alterations are predictive of an increased risk of cardiovascular events; 3) changes in IMT occur during antihypertensive treatment; 4) at least one study has shown differential effects of different antihypertensive agents on IMT (VHAS: verapamil better than chlorthalidone); 5) in this study a greater effect on IMT has been accompanied by a reduced cardiovascular event rates. Larger studies are desirable to confirm these conclusions.
Zanchetti
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Istituto di Clinica Medica Generale e Terapia Medica, and Centro di Fisiologia Clinica e Ipertensione, Università di Milano, Ospedale Maggiore, Italy.
D000368:Aged; D000792:Angiography; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000188:drug therapy* / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012907:Smoking; D013997:Time Factors; D014463:Ultrasonography
D000959:Antihypertensive Agents