Large artery wall thickening and its determinants under antihypertensive treatment: the IMT-INSIGHT study.
BACKGROUND
Calcium antagonists retard progression of intima-media thickness (IMT), but whether this retardation covers heterogeneous individual patient responses of IMT change is unknown.


METHODS
Hypertensive patients treated for 4 years with nifedipine (n = 115) or coamilozide (n = 127) underwent ultrasound measurements of carotid IMT at baseline, 4 months later, and then every year.


RESULTS
A histogram of individual slopes of IMT change (least square regression of IMT to time) during treatment identified three categories of slopes according to the 20th and 80th percentiles of distribution: lower, intermediate and higher percentiles of IMT slope; the proportion of categories of IMT slope differed between treatments (P < 0.05), due to a more frequent lower slope percentile under nifedipine (27%) than under coamilozide (14%); within-group differences between IMT slope categories were: (i) increased baseline IMT associated with lower IMT slope percentile in nifedipine group (P < 0.001) and (ii) more frequent carotid plaque associated with higher IMT slope percentile in both treatment groups (P < 0.05). Analysis of overall patients showed that IMT slope was associated negatively with nifedipine treatment (P < 0.01) and baseline IMT (P < 0.001) and positively with carotid plaque (P < 0.01); the relationship between IMT slope and baseline IMT was negative under nifedipine and flat under coamilozide, and the presence of plaque reset both relationships towards a higher IMT slope; the between-treatment difference in IMT slope was different between tertiles of baseline IMT (P = 0.016).


CONCLUSIONS
The differences in IMT slope between nifedipine and coamilozide increase with increasing baseline IMT.
Gariepy
Jerome
J
Centre de Médecine Préventive Cardiovasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Broussais, and UMR CNRS 7131, Paris, France.
Simon
Alain
A
Chironi
Gilles
G
Moyse
Dominique
D
Levenson
Jaime
J
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D017536:Carotid Artery, Common / Q000187:drug effects* / Q000473:pathology*; D016893:Carotid Stenosis / Q000188:drug therapy / Q000473:pathology; D004232:Diuretics; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009543:Nifedipine / Q000627:therapeutic use; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013223:Statistics as Topic; D016896:Treatment Outcome; D017539:Tunica Intima / Q000187:drug effects / Q000473:pathology; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D014665:Vasodilator Agents; D009543:Nifedipine