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(Circulation. 2001;103:2949.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Differential Effects of Nifedipine and Co-Amilozide on the Progression of Early Carotid Wall Changes

Alain Simon, MD; Jérome Gariépy, MD; Dominique Moyse, PhD; Jaime Levenson, MD

From the Centre de Médecine Préventive Cardiovasculaire, Hôpital Broussais, Paris, France.

Correspondence to Alain Simon, Centre de Médecine Préventive Cardiovasculaire, Hôpital Broussais, 96 Rue Didot, 75674 Paris, France. E-mail alain.simon{at}brs.ap-hop-paris.fr

Background—Common carotid artery intima-media thickness (IMT) progression was compared between 4 years of treatment with nifedipine and diuretic.

Methods and Results—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 () in IMT, diameter, and CSA-IMT. In the until-end-of-study population, between-treatment differences existed in IMT progression rate (P=0.002), IMT (P=0.001), and 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 IMT (P=0.004) and 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), IMT (P=0.005, 0.001, 0.005), and 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.

Conclusions—A difference in early carotid wall changes is shown between 2 equally effective antihypertensive treatments.

Key Words: carotid arteries • hypertrophy • hypertension • drugs

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