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(Stroke. 2006;37:1933.)
© 2006 American Heart Association, Inc.

Progress Reviews

Carotid Intima-Media Thickness and Antihypertensive Treatment

A Meta-Analysis of Randomized Controlled Trials

Ji-Guang Wang, MD, PhD; Jan A. Staessen, MD, PhD; Yan Li, MD, PhD; Luc M. Van Bortel, MD, PhD; Tim Nawrot, PhD; Robert Fagard, MD, PhD; Franz H. Messerli, MD Michel Safar, MD

From the Studies Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Cardiovascular Diseases, University of Leuven, Belgium (J.G.W., J.A.S., R.F., T.N.); the Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, Shanghai Jiaotong University, China (J.G.W., Y.L.); the Heymans Institute of Pharmacology, University of Ghent, Belgium (L.V.B.); the Hypertension Program, Division of Cardiology, St. Luke’s-Roosevelt Hospital, New York, NY (F.H.M.); and the Diagnosis Center, Hopital Hotel-Dieu, Paris, France (M.S.).

Correspondence to Ji-Guang Wang, MD, PhD, Shanghai Institute of Hypertension, Ruijin 2nd Road 197, Shanghai 200025, China. E-mail jiguangwang{at}netscape.net Reprint requests to Jan A. Staessen, MD, PhD, Laboratory of Hypertension, Campus Gasthuisberg, Herestraat 49, Leuven 3000, Belgium. E-mail jan.staessen@med.kuleuven.be

Background and Purpose— 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 ß-blocker, or a calcium-channel blocker (CCB), compared with placebo or no-treatment, reduced the rate of intima-media thickening by 7 µm/year (P=0.01). In 9 trials including 4564 hypertensive patients, CCBs, ACE inhibitors, an angiotensin II receptor blocker or an -blocker, compared with diuretics or ß-blockers, in the presence of similar blood pressure reductions, decreased intima-media thickening by 3 µm/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 µm/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 µm/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.

Key Words: blood pressure • carotid arteries • meta-analysis • randomized controlled trials

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