What is the clinical evidence from this study?

Study design: RCT. Population: Hypertension (n=69). Intervention: Amlodipine vs. Lisinopril (5-20 mg daily). Primary outcome: Change in common carotid artery intima-media thickness (p=<0.05).

What question did this study set out to answer?

To determine whether blood pressure reduction with amlodipine or lisinopril leads to differential structural remodeling of the common carotid artery in hypertensive patients.

September 21, 2001Clinical Science

Effects of blood pressure lowering with amlodipine or lisinopril on vascular structure of the common carotid artery

Q: What are the key findings of this study?

Amlodipine induced a significantly greater decrease in common carotid artery intima-media thickness (-0.048 mm) compared to lisinopril (-0.027 mm) over 1 year in hypertensive patients (P<0.05).

Q: What question did this study set out to answer?

To determine whether blood pressure reduction with amlodipine or lisinopril leads to differential structural remodeling of the common carotid artery in hypertensive patients.

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Key result

Amlodipine induced a significantly greater decrease in common carotid artery intima-media thickness (-0.048 mm) compared to lisinopril (-0.027 mm) over 1 year in hypertensive patients (P<0.05).

Why the study?

Does amlodipine compared to lisinopril improve common carotid artery intima-media thickness in previously untreated patients with hypertension?

Population

69 previously untreated patients with hypertension

Comparison

Amlodipine 5-10 mg daily for 1 year vs Lisinopril 5-20 mg daily for 1 year

Design

RCT, allocated randomly, double-blind

Follow-up

1 year

Authors

ASAlice StantonPreventive Cardiology JCJeremy N. CHAPMANLung Institute JMJamil MayetGeneral Cardiology

Discussion

Member takes

Implication

Amlodipine vs comparator may differentially affect carotid IMT; extends class-specific vascular effects data in hypertension.

Key Points

To determine whether blood pressure reduction with amlodipine or lisinopril leads to differential structural remodeling of the common carotid artery in hypertensive patients.
Double-blind parallel-group randomized clinical trial involving 69 previously untreated patients with hypertension assigned to 1 year of amlodipine (5–10 mg daily) or lisinopril (5–20 mg daily).
Adjunctive treatment with doxazosin and bendrofluazide was added when necessary to attain equivalent blood pressure control.
Common carotid artery intima-media thickness decreased by 0.048 mm (95% CI -0.066, -0.031 mm) with amlodipine versus 0.027 mm (95% CI -0.046, -0.007 mm) with lisinopril (P < 0.05).
Lumen diameter decreased significantly only with lisinopril (-0.21 mm [95% CI -0.32, -0.11 mm] vs amlodipine -0.02 mm [95% CI -0.14, 0.10 mm]; P < 0.02), whereas intima-media area reductions (-1.32 mm² vs -1.26 mm²) and blood pressure reductions did not differ significantly.

Study Design

Type

RCT (n=69)

Blinding

Double-blind

Randomization

Randomized

Structured PICO

Does amlodipine compared to lisinopril improve common carotid artery intima-media thickness in previously untreated patients with hypertension?

Population

69 previously untreated patients with hypertension followed for 1 year.

Intervention

Amlodipine 5-10 mg daily for 1 year (with doxazosin and bendrofluazide added if required to achieve BP control)

Comparator

Lisinopril 5-20 mg daily for 1 year (with doxazosin and bendrofluazide added if required to achieve BP control)

Outcome

Common carotid artery intima-media thickness at 12 monthssurrogate

Main Result

Absolute Event Rate: -0.048% vs -0.027%

p-value: p=<0.05

Amlodipine induces greater regression of common carotid artery intima-media thickness compared to lisinopril in hypertensive patients, despite similar blood pressure reductions.

Limitations

It remains to be established whether differences in structural regression confer a prognostic advantage.
Unknown whether the observed structural differences confer a prognostic advantage

Cite This Study

Stanton et al. (2001) conducted an RCT in Hypertension (n=69). Amlodipine vs. Lisinopril (5-20 mg daily) was evaluated on Change in common carotid artery intima-media thickness (p=<0.05). Amlodipine induced a significantly greater decrease in common carotid artery intima-media thickness (-0.048 mm) compared to lisinopril (-0.027 mm) over 1 year in hypertensive patients (P<0.05).

synapsesocial.com/papers/6a6f1dcc35aa2c282ce08475 https://doi.org/10.1042/cs1010455

Topics

Hypertension management

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Effects of blood pressure lowering with amlodipine or lisinopril on vascular structure of the common carotid artery

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Effects of blood pressure lowering with amlodipine or lisinopril on vascular structure of the common carotid artery

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider