Trials investigating the anti-atherosclerotic effects of antihypertensive drugs.

METHODS OF CURRENT TRIALS

Several ongoing trials are investigating the anti-atherosclerotic effects of antihypertensive drugs in hypertensive patients. Changes in carotid intimal-medial thicknesses and atherosclerotic plaques are being explored by a sensitive quantitative B-mode ultrasound technique. MULTICENTER ISRADIPINE/DIURETIC ATHEROSCLEROSIS STUDY (MIDAS): The results from this pioneering study indicated a slower progression, at least in the first 6 months, of carotid plaques in isradipine-treated patients than in diuretic-treated patients. MIDAS has been particularly valuable in giving information on the rate of growth of intimal-medial thickness in hypertensive patients and on the best end-point to use in carotid ultrasound trials. EUROPEAN LACIDIPINE STUDY ON ATHEROSCLEROSIS (ELSA) AND VERAPAMIL IN HYPERTENSION AND ATHEROSCLEROSIS STUDY (VHAS): Baseline data from these two ongoing studies have provided evidence of the very high prevalence of carotid lesions among hypertensive patients: the prevalence of plaques (defined as a carotid intimal-medial thickness of > or = 1.3 mm) was 83% in ELSA, while in VHAS, in which plaques were defined as an intimal-medial thickness of > 1.5 mm), the plaque prevalence was 37%. These observations emphasize the importance of evaluating the atherosclerotic action of antihypertensive agents. PLAQUE HYPERTENSION LIPID-LOWERING ITALIAN STUDY (PHYLLIS): This trial is using a factorial design to explore the anti-atherosclerotic action of an angiotensin converting enzyme (ACE) inhibitor (fosinopril) versus a diuretic, and also intends to evaluate the possible benefits of associating antihypertensive therapy with a statin to induce lipid-lowering to prevent the progression of carotid atherosclerosis.