Carotid intima-media thickness and antihypertensive treatment: a meta-analysis of randomized controlled trials.
OBJECTIVE
Hypertension promotes carotid intima-media thickening. We reviewed the randomized controlled trials that evaluated the effects of an antihypertensive drug versus placebo or another antihypertensive agent of a different class on carotid intima-media thickness.


METHODS
We searched the PubMed and the Web of Science databases for randomized clinical trials, published in English before 2005, and included 22 trials.


RESULTS
In 8 trials including 3329 patients with diabetes or coronary heart disease, antihypertensive treatment initiated with an angiotensin-converting enzyme (ACE) inhibitor, a beta-blocker, or a calcium-channel blocker (CCB), compared with placebo or no-treatment, reduced the rate of intima-media thickening by 7 microm/year (P=0.01). In 9 trials including 4564 hypertensive patients, CCBs, ACE inhibitors, an angiotensin II receptor blocker or an alpha-blocker, compared with diuretics or beta-blockers, in the presence of similar blood pressure reductions, decreased intima-media thickening by 3 microm/year (P=0.03). The overall beneficial effect of the newer over older drugs was largely attributable to the decrease of intima-media thickening by 5 microm/year (P=0.007) in 4 trials of CCBs involving 3619 patients. In 5 trials including 287 patients with hypertension or diabetes, CCBs compared with ACE inhibitors did not differentially affect blood pressure, but attenuated intima-media thickening by 23 microm/year (P=0.02). The treatment induced changes in carotid intima-media thickness correlated with the changes in lumen diameter (P=0.02), but not with the differences in achieved blood pressure (P>0.53).


CONCLUSIONS
CCBs reduce carotid intima-media thickening. This mechanism might contribute to their superior protection against stroke.
Wang
Ji-Guang
JG
Studies Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, University of Leuven, Belgium. jiguangwang@netscape.net
Staessen
Jan A
JA
Li
Yan
Y
Van Bortel
Luc M
LM
Nawrot
Tim
T
Fagard
Robert
R
Messerli
Franz H
FH
Safar
Michel
M
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000401:mortality; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control*; D003327:Coronary Disease / Q000150:complications; D048909:Diabetes Complications / Q000188:drug therapy; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006965:Hyperplasia; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000648:ultrastructure; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000648:ultrastructure; D014463:Ultrasonography
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors