Zanchetti A, Magnani B, Dal Palù C
Institute of Clinical Medicine, University of Milan, Italy.
J Hum Hypertens. 1992 Dec;6 Suppl 2:S45-8.
Whether or not some classes of antihypertensive drugs have an anti-atherogenic action independent of the antihypertensive one has been investigated through a large series of experimental studies, primarily involving calcium antagonists. Most experimental investigations have shown a significant anti-atherogenic action of calcium antagonists, but only when the drug is administered simultaneously with the atherogenic stimulus (mainly cholesterol feeding). When the drug is administered weeks or months after the beginning of the atherosclerotic process (as in the Watanabe heritable hyperlipidemic rabbit), with a single exception, no antiatherogenic effect has been shown. The few clinical studies completed so far have been on symptomatic coronary patients. Little is known of the effects of calcium antagonists on asymptomatic lesions in the carotid arteries of hypertensive patients, in whom carotid plaques can be identified and followed-up by non-invasive ultrasound techniques. However, two such trials are underway. The Verapamil in Hypertension Atherosclerosis Study (VHAS) is an ongoing randomized trial, comparing the antihypertensive efficacy of verapamil 240 mg SR with chlorthalidone 25 mg in 1,464 essential hypertensives aged 40-65 years. In a random subgroup of patients (500), who will be followed for three years, B-mode ultrasonography is being carried out blindly to evaluate the effect of the two drugs on carotid wall thickness and on carotid plaques, when present. Preliminary baseline data are available in 440 of the hypertensive patients in whom ultrasound investigation was performed. The mean (+/- SD) age of these patients was 53.7 +/- 6.9 years; 32.5% had echocardiographically normal carotid walls; 30.9% showed intima-media thickening; and 36.6% had one or more plaques.(ABSTRACT TRUNCATED AT 250 WORDS)
一些抗高血压药物是否具有独立于降压作用之外的抗动脉粥样硬化作用，已通过大量实验研究进行了调查，主要涉及钙拮抗剂。大多数实验研究表明钙拮抗剂具有显著的抗动脉粥样硬化作用，但仅当药物与致动脉粥样硬化刺激因素（主要是喂食胆固醇）同时给药时才会如此。当在动脉粥样硬化过程开始数周或数月后给药（如在渡边遗传性高脂血症兔中），除了一个例外情况，未显示出抗动脉粥样硬化作用。目前完成的少数临床研究是针对有症状的冠心病患者。对于钙拮抗剂对高血压患者颈动脉无症状病变的影响知之甚少，而通过非侵入性超声技术可以识别和随访这些患者的颈动脉斑块。然而，两项此类试验正在进行中。维拉帕米高血压动脉粥样硬化研究（VHAS）是一项正在进行的随机试验，在1464名40 - 65岁的原发性高血压患者中比较240毫克缓释维拉帕米与25毫克氯噻酮的降压疗效。在一个随机亚组患者（500名）中，将对其进行三年随访，正在盲目进行B型超声检查，以评估这两种药物对颈动脉壁厚度以及存在的颈动脉斑块的影响。在进行超声检查的440名高血压患者中可获得初步基线数据。这些患者的平均（±标准差）年龄为53.7±6.9岁；32.5%的患者颈动脉壁超声心动图检查正常；30.9%的患者显示内膜中层增厚；36.6%的患者有一个或多个斑块。（摘要截断于250字）
