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 greater than or equal to 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.