Carotid intima media thickness (CIMT) is frequently increased in hypertensive patients, correlated with blood pressure levels but clinical trials have evaluated the effect of different antihypertensive drugs on CIMT with contradictory results. Because of these conflicting results, our work aimed to address these questions by realizing a meta-analysis on all randomized controlled trials studying the effects of different antihypertensive products on the CIMT.
We systematically reviewed all randomized controlled trials of antihypertensive treatment on CIMT. 29 trials were identified in three databases. We conducted a combined analysis of antihypertensive effects using the overall effect.
A significant positive overall effect size on global comparison of CIMT with antihypertensive drugs compare to placebo was found using a random effect model (−0.08 [−0.13; −0.03]). Overall effect sizes were significant for ACE (−0.08 [−0.14; -0.02]) and beta blockers (−0.09 [−0.19; 0.05]) versus placebo. Data did not allow other comparison versus placebo. Significant and beneficial overall effect size was observed for Calcium antagonists compare to both ACE (0.37 [0.20; 0.54]) and Diuretics (−0.09 [−0.16; −0.02]). Significant and beneficial overall effect size was observed for AT1 compare to Beta blockers (0.61 [0.46; 0.77]). In subgroup analysis, significant and beneficial overall effect size was found both for low and high decrease in blood pressure, for baseline CIMT lower or equal than 0.82 in contrast with CIMT greater than 0.82 and for treatment duration less than 24 months in contrast with an increase in CIMT after 24 months.
anti-hypertensive treatment is associated with a significant decrease of CIMT. Calcium channel blockers are the most effective treatment follow by ACE inhibitors. Standardization of the protocols of measurements of the CIMT is required to assess longterm effects of CIMT reduction on cardiovascular morbi-mortality.Le texte complet de cet article est disponible en PDF.