Differential effects of nifedipine and co-amilozide on the progression of early carotid wall changes.
BACKGROUND
Common carotid artery intima-media thickness (IMT) progression was compared between 4 years of treatment with nifedipine and diuretic.


RESULTS
This study, ancillary to the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT), involved nifedipine 30 mg or co-amilozide (hydrochlorothiazide 25 mg and amiloride 2.5 mg) with optional subsequent titration. Among 439 randomized hypertensive patients, 324 had >/=1 year of follow-up (intent-to-treat group), and 242 completed follow-up (until-end-of-study group). Ultrasonography was performed at baseline, 4 months later, and then every year. Central computerized reading provided far-wall IMT, diameter, and cross-sectional area IMT (CSA-IMT). The primary outcome was IMT progression rate (slope of IMT-time regression). Secondary outcomes were changes from baseline (Delta) in IMT, diameter, and CSA-IMT. In the until-end-of-study population, between-treatment differences existed in IMT progression rate (P=0.002), Delta IMT (P=0.001), and Delta CSA-IMT (P=0.006), because IMT progressed on co-amilozide but not on nifedipine. In the intent-to-treat population, treatment differences existed in Delta IMT (P=0.004) and Delta CSA-IMT (P=0.04) but not in IMT progression rate (P=0.09). Patients with >/=2, 3, or 4 years of follow-up showed treatment differences in IMT progression rate (P=0.04, 0.004, 0.007, respectively), Delta IMT (P=0.005, 0.001, 0.005), and Delta CSA-IMT (P=0.025, 0.013, 0.015). Diameter decreased more on co-amilozide than on nifedipine in the intent-to-treat population (P<0.05), whereas blood pressure decreased similarly on both treatments.


CONCLUSIONS
A difference in early carotid wall changes is shown between 2 equally effective antihypertensive treatments.
Simon
A
A
Centre de Médecine Préventive Cardiovasculaire, Hôpital Broussais, Paris, France. alain.simon@brs.ap-hop-paris.fr
Gariépy
J
J
Moyse
D
D
Levenson
J
J
D000368:Aged; D000369:Aged, 80 and over; D000584:Amiloride / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001262:Atenolol / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D004232:Diuretics; D004338:Drug Combinations; D014665:Vasodilator Agents; D006852:Hydrochlorothiazide; D001262:Atenolol; C010247:amiloride, hydrochlorothiazide drug combination; D004656:Enalapril; D000584:Amiloride; D009543:Nifedipine