Simon A, Gariépy J, Moyse D, Levenson J
Centre de Médecine Préventive Cardiovasculaire, Hôpital Broussais, Paris, France.
Circulation. 2001 Jun 19;103(24):2949-54. doi: 10.1161/01.cir.103.24.2949.
Common carotid artery intima-media thickness (IMT) progression was compared between 4 years of treatment with nifedipine and diuretic.
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.
A difference in early carotid wall changes is shown between 2 equally effective antihypertensive treatments.
比较硝苯地平和利尿剂治疗4年期间颈总动脉内膜中层厚度（IMT）的进展情况。
本研究是国际硝苯地平控释片研究：高血压治疗目标干预（INSIGHT）的辅助研究，涉及30 mg硝苯地平或复方阿米洛利（氢氯噻嗪25 mg和阿米洛利2.5 mg），并可选择后续滴定。在439例随机分组的高血压患者中，324例有≥1年的随访（意向性治疗组），242例完成随访（至研究结束组）。在基线、4个月后以及随后每年进行超声检查。中央计算机化读数提供远壁IMT、直径和横截面面积IMT（CSA-IMT）。主要结局是IMT进展率（IMT-时间回归斜率）。次要结局是IMT、直径和CSA-IMT相对于基线的变化（Δ）。在至研究结束人群中，IMT进展率（P = 0.002）、ΔIMT（P = 0.001）和ΔCSA-IMT（P = 0.006）存在治疗差异，因为复方阿米洛利治疗时IMT进展，而硝苯地平治疗时未进展。在意向性治疗人群中，ΔIMT（P = 0.004）和ΔCSA-IMT（P = 0.04）存在治疗差异，但IMT进展率无差异（P = 0.09）。随访≥2年、3年或4年的患者在IMT进展率（分别为P = 0.04、0.004、0.007）、ΔIMT（P = 0.005、0.001、0.005）和ΔCSA-IMT（P = 0.025、0.013、0.015）方面存在治疗差异。在意向性治疗人群中，复方阿米洛利治疗时直径的下降幅度大于硝苯地平（P<0.05），而两种治疗的血压下降情况相似。
两种同样有效的降压治疗在早期颈动脉壁变化方面存在差异。
