on June 8, 2006
Published online before print June 8, 2006, doi: 10.1161/01.STR.0000227223.90239.13
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Submitted on January 6, 2006
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.). * To whom correspondence should be addressed. E-mail: jiguangwang{at}netscape.net.
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 Conclusions--CCBs reduce carotid intima-media thickening. This mechanism might contribute to their superior protection against stroke.
Revised on April 18, 2006
Accepted on April 28, 2006
Carotid Intima-Media Thickness and Antihypertensive Treatment. A Meta-Analysis of Randomized Controlled Trials
Ji-Guang Wang MD, PhD*;
-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 -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).
Key words: blood pressure • carotid arteries • meta-analysis • randomized controlled trials
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