Risk factors associated with alterations in carotid intima-media thickness in hypertension: Baseline data from the European Lacidipine Study on Atherosclerosis

Alberto Zanchetti, M. Gene Bond, Michael Hennig, Albrecht Neiss, Giuseppe Mancia, Cesare Dal Palù, Lennart Hansson, Bruno Magnani, Karl Heinz Rahn, John Reid, Josè Rodicio, Michel Safar, Lothar Eckes, Raffaella Ravinetto, A. Zanchetti, M. G. Bond, C. Dal Palù, L. Hansson, M. Hennig, B. MagnaniG. Mancia, A. Neiss, K. H. Rahn, J. Reid, J. Rodicio, M. Safar, L. Eckes, R. Ravinetto, R. Tong, R. M. Phillips, S. Alcorn, D. Angel, J. Craig, B. Holley, M. Li, T. Miller, D. Pozo, M. Rodriguez, B. Xiao, C. Wilson, M. Wolfe, B. Thomasson, F. Rohlmann, B. Flatau, G. Parati, S. Omboni, A. Ravogli, A. Villani, C. Santucciu, L. Ulian, A. Rappelli, R. Catalini, O. Zingaretti, P. Toutouzas, Ch Pitsavos, I. Kallikazaros, D. Tsekoura, K. Tsioufis, A. Roca Cusachs, E. Negredo, C. Paytubì Garì, J. Scholze, G. Stuhr, C. Wolbart, E. Ambrosioni, E. Strocchi, M. Piccoli, M. Schiaratura, E. Agabiti Rosei, G. Bettoni, M. L. Muiesan, H. J. Gilfrich, A. Römer, K. Schüller-Mirza, P. Wintrich, H. Elliot, R. Carter, S. J. Johnston, K. Shields, I. Sim, J. M. Mallion, M. Chevallier, D. Ploin, C. Hamm, B. Goldmann, C. Schlüter, T. Thulin, L. Averfalk-Ohlsson, K. Falk, L. Ruilope, M. Cruz-Casal, M. L. Fernandez, C. Cuspidi, G. Leonetti, A. Lanfranchi, R. Paliotti, H. Holzgreve, A. Mastellotto, S. Reder, M. Barenbrock, B. Suwelack, J. Witta, F. Zannad, J. C. Becker, P. Mizzon, B. Trimarco, N. De Luca, G. L. Iovino, A. Pessina, P. Pauletto, S. Da Ros, V. Pagliara, S. Laurent, R. Asmar, O. Crisan, A. Salvetti, F. Arzilli, M. Sgrò, M. Simi, A. Bucci, S. Gioia, G. Modestini, L. Ramsey, M. Wright, V. Thompson, U. de Faire, U. Hellmark-Augustsson, L. Nilson, D. Barjhoux, J. L. Bernard, M. Bernard, L. Casado, C. Cavat, T. Chan, B. Chassery, P. Claustre, J. M. Dessaint, J. Eymin, C. Fouillard, C. Galavielle, E. Garrel, P. Imbert, M. C. Jacob, J. P. Lanzi, P. J. Laye, M. Menon, J. Peronnet, G. Perrin, T. Pirola, M. Riffard, B. Rougier, M. Salvi, J. M. Senechal, J. F. Sliwinski, J. M. Vaillant, S. A. Yem, G. Villeger, P. Jallon, J. Leleu, J. Wolga, G. Petit, P. Buffler, Y. Terrel, B. Longobardi, A. Bellin, M. C. Gerbaud-Fournier, M. Gaget-Lazarotto, L. Moretton, G. Durand, Y. Aubry, M. Benichou, F. Caubel, M. Champagne-Grill, P. Dalmard, J. Dillinger, F. Durupt, C. Eiden, A. Ferretti, C. Gall, M. Girerd, B. Godfrin, F. Grosjean, A. Grunenwald, A. Guillou, P. Hanrion, B. Kimmel, L. Lambert, F. Lardenois, C. Laurent, P. Lauvray, J. M. Lecossois, C. Maquaire, G. Munier, A. Pavljasevic, M. Perette, A. Petit, J. P. Pigeon, P. Reinhart, P. Remot, D. Richter, F. Sauvage, J. Gueib, G. Silvestri, L. P. Trompette, G. Vaillant, P. Vespignani, Y. Dhyvert, K. Bacha, P. Bastien, M. Bernard, G. Bertrand, F. Blondin, A. Cugnot, E. Dechoux, J. M. Demurger, P. Firholz, J. P. Foucart, M. F. Gerard, M. Gibelli, A. Gueusquin, D. Henle, D. Henrion, F. Jacobs, E. Klein, B. Kolmayer, O. Lochard, P. Martin, C. Nygon Ulrich, L. Pinze, V. Ratsianoharana, J. P. Simon, J. Vogel, P. Wagner, G. Walter, J. M. Weber, J. Azoulay, C. Baranes, J. J. Dray, A. Kissous, H. N'Guyen Nhu, H. H. Pujade, P. Zaks, J. Rebot, J. P. Aubert, P. Audouy, C. Bidault-La-Pomme, A. Bolo, J. Boujenah, A. Hamou, S. Jaoui, C. Lortholary N'Guyen, H. Moula, K. D. N'Guyen, F. M'Bappe, J. J. Courland, L. Benichou, J. Y. Garnier, V. Labbe, P. Le Roux, B. Francoz, Y. Keddache, E. Cherel, G. Henry, M. Gauthier, D. Garelik, G. Levy, M. Bachot, S. Dumas, G. Alezra, M. Naniche, C. Fieyre, E. Machin, M. Abdel-Qadez, H. Benduhn, J. Berling, J. Bessel, M. Beudt, K. Bona, W. Borngräber, J. Bott, H. J. Bremermann, W. Bringmann, K. H. Brückner, G. Bundrock, A. Cegla, H. Damaschke, H. J. Demmig, R. Dieke, B. Domigalle, H. Eisenkopf, N. Eisenkopf, I. Ernst, C. Fichtler, S. Fischer, R. Förster, M. Frick, J. Frille, L. Gabriel, S. Gaydov, C. Gärtner, T. Giehrt, P. Gründhal, R. Hamann, R. Hartmann, M. Heim, B. Hellinger, H. E. Henke, M. Hill, H. Hintz, R. Horn, G. von Hummel, I. Hunecke, W. Illgen, E. John, S. Jünger, T. Kammermeier, G. Kässner, S. Kaspari, E. Kellner, R. Kemper, B. Kersting, T. Kersting, M. Kirsche, C. Klein, E. Klüssendorf-Mediger, W. Kranzbühler, P. Kretschmar, A. Krieger, E. U. Krohn, R. Kuhnen, G. Leo, S. Leszke, A. Link, D. Löhndorf, H. P. Ludwig, P. März, K. Mayer, J. Mey, D. Meyer-Carlstädt, J. Minnich, D. Müller, B. Neeb, U. Nemec-Held, J. Nies, C. Oppermann, M. Orlowski, G. Overmeyer, M. Pahl, W. Poswiat, R. Preuß, R. Raabe, M. Riad, K. Richter, R. Rippert, D. Ross, H. Ruppel, E. Rutkowsky, R. Santo, M. Sellier, M. Simonsohn, B. P. Smollich, C. Spieker, M. Suter, B. Schlaak, J. Schmeck, A. Schröder, T. Schubert, V. Schuldt, K. M. Schussmann, D. Schwarz, W. Schwarz, V. Stallbaum, C. Steidle, B. Steinberg, A. Stolte, B. Strauß, W. von Tils, A. Triebel, R. Uhlig, H. G. Voss, R. Warncke, G. Weber, H. C. Weber, F. Weberling, W. Weiland, J. Weimer, H. W. Wozny, C. Zekorn, P. Zierz, Z. Psomadaki, G. Papazachos, D. Papadogiannis, Ch Panagoulis, M. Papavassiliou, F. Valvis, D. Metzikof, K. Karydis, S. Kakouros, A. Manolis, S. Foussas, E. Papasteriadis, S. Giokas, G. Spanos, P. Dessì, E. Espinosa, P. Gagliardi, E. Paciaroni, R. Antonicelli, S. Bassotti, A. Carotti, C. Rondanini, D. Caporicci, C. Palpacelli, F. Pellegrini, F. Mircoli, R. Amici, P. Volpe, E. Rossi, A. Negro, F. Perazzoli, S. Signorelli, I. Argentini, F. Ippolito, I. Portioli, M. Zini, R. Agosta, T. Craincevich, G. Pinelli, A. Grepioni, F. Portaluppi, S. Bacchelli, D. Degli Esposti, M. Pasin, S. Bosi, C. Bellet, P. Rodella, G. Garavelli, E. Madini, M. Borghi, G. Cavaliere, G. Nordio, B. Cerri, M. Cefis, D. Cristini, T. Ferrari, G. Ghislotti, W. Piubello, E. Vitali, C. Proto, B. Bombagi, R. Scapaticci, P. Migliorati, E. Vavassori, F. Zuccato, G. Pasini, R. Beretta, M. T. Lavazza, C. Costantini, A. Cadel, B. Pria, R. Casati, M. G. De Amici, U. G. Cereda, P. Novati, R. Cappelletti, M. Cristofari, A. U. Ferrari, L. Terzoli, G. Finardi, V. Ravetta, G. Gibelli, G. Castiglioni, F. Locatelli, C. Dell'Oro, A. Monteverde, F. Lunati, M. Campanini, P. Recalcati, G. Carantani, E. Ronchi, G. Palumbo, S. Jucker, D. Taglioretti, V. Racca, A. Vaccarella, V. Russo, A. Carnovale, O. De Divitiis, S. Di Somma, A. Petrocelli, U. de Martino, L. Greco, C. De Matteis, N. Forni, T. Messore, E. Landmann, G. Pucciarelli, A. Setaro, L. Romis, M. Sorace, G. B. Ambrosio, C. Slongo, G. Scannapieco, L. Borsato, F. Pegoraro, G. Laurini, M. Marzola, N. Caruso, M. Vanin, D. Causarano, G. Santagati, M. E. De Antoni, W. Donadon, G. Zanette, G. Bertoli, S. Martinelli, M. Velo, C. Martines, S. Bongiovi, P. Palatini, M. Santonastaso, M. Pace, L. Mario, R. Rocchi, D. Dorigatti, C. Canali, A. Pantaleoni, A. Di Marco, P. Spandri, M. Scatasta, S. Sperotto, G. Diamanti, A. Bini, F. Nassi, A. Bianchini, M. Zampollo, S. Frangioni, G. Federighi, F. Cipollini, R. Nami, F. Panza, D. Lamanna, C. Del Prato, P. Saba, R. Giovannetti, R. Guerra, A. Achilli, G. De Spirito, G. Toglia, F. Ferri, F. Pertosa, A. Panzacchi, G. Gambelli, F. Imola, M. T. Cifarelli, G. Lalloni, R. R. Pastorelli, A. M. Galliano, M. Santini, L. Antonini, L. M. Ruilope, E. Vinyolas, R. Sorribes, A. Dalfo, J. Vila, X. Mundel, E. Juncadella, J. M. Fandos, C. Martin, L. de Marcos, E. Torrent, J. Pous, S. Garcia, J. Franch, M. T. Benet, R. Bachmann, T. Karlsson, I. Brunkstedt, I. Enström-Granath, T. Thulin, B. Fagher, U. Gårdinger, B. Carlstedt, J. Klefter, L. Kvist, P. Löfdahl, O. Malm, P. Nilsson, A. Segerslätt-Andersson, P. Å Tegstam, C. E. Voss, M. Bengtsson, C. Hjortsberg, F. Wagner, L. Bergsten, M. Bjurström, I. Bäckström, J. Engström, S. Grimfors, K. Gyllenhammar, S. Hollenberg, C. Höglund, G. Jacobsson-Billfors, L. Kacner, T. Kahan, A. Carlsson, B. Lejd, A. Lindh, Å Peterson, M. Smith-Carlsson, L. Warselius, V. Åhgren, J. Östergren, E. Galiatsou, Y. MacYlvenna, F. Dunn, M. Brown, F. Davidson, S. Glen, B. Adams-Strump, B. Glekin, B. Robson, A. C M Morrison, S. Walsh, P. Dawes, K. Pickering, M. Willens, A. G. Wade, G. Crawford, S. Murray, G. Martin, L. Hamilton, J. Hannah, K. Mack, A. Potter, A. Power, P. Sheridan, E. Caven, P. R. Jackson, E. J. Wallis, W. W. Yeo, I. U. Haq, S. Sherriff, T. M. Broadhead, R. L. Palmer, E. C. Lister

Research output: Contribution to journalArticle

Abstract

Background. The possibility that calcium antagonists exert an anti-atherosclerotic action at least partly independently of the blood-pressure-lowering effect is supported by results of a large number of experimental studies and can now be investigated by quantitative B-mode ultrasound imagining of the carotid artery walls. Design. The European Lacidipine Study on Atherosclerosis (ELSA) is a prospective, randomized, double-blind, multinational trial comparing effects of 4-year treatment based on the long-acting, highly lipophilic calcium antagonist lacidipine with those of treatment based on the β-blocker atenolol on the development of carotid artery wall alterations in patients (aged 45-75 years) with mild-to-moderate hypertension (systolic blood pressure 150-210 mmHg and diastolic blood pressure 95-115 mmHg). While the intervention study is progressing, this article summarizes baseline data obtained from the whole cohort of 2259 patients randomly allocated to treatment. Methods. Baseline ultrasound data were obtained from two replicate examinations performed shortly before random allocation to treatment by certified sonographers at 23 referral centres and read at the ultrasound coordinating centre at the Wake Forest University School of Medicine. Intima-media thickness was measured at up to 12 different sites in the carotid artery tree and expressed as the mean of the maxima at these sites (M(max)), the mean of the maxima at four sites in the distal common carotid artery and bifurcation (CBM(max)) and the maximum intima-media thickness (T(max)). Baseline demographic and clinical measurements were performed by investigators in 410 peripheral clinical units and 24 h ambulatory blood pressure monitorings read and validated by members of a centralized unit at the University of Milan. The statistical analysis centre at the Technische Universitat Munchen received and analysed all baseline data, by calculating means ± SD, medians and ranges and performing correlation (Spearman correlation coefficients) and multiple regression analyses. Results. Prevalence of carotid artery wall alterations among the hypertensive patients randomly allocated to treatment in the USA was very high: 82% had T(max) ≤ 1.3 mm ('plaques' according to protocol) and 17% had T(max) ≤ 1.0 and <1.3 mm ('thickening'), with a median of two plaques per patient. We found significant correlations between ultrasound measurements and the following demographic and clinical variables: age, sex, systolic blood pressure and pulse pressure (both clinic and ambulatory), concentrations of total, high-density lipoprotein and low-density lipoprotein cholesterol and triglycerides, smoking habit and duration of hypertension. We found no significant correlation to diastolic blood pressure and glucose concentration. A multiple regression analysis indicated significant variables in the following rank order: age, 24 h ambulatory pulse pressure, sex, low-density lipoprotein cholesterol concentration, triglyceride concentration, smoking and clinic systolic blood pressure. Conclusions. Analysis of baseline data from the ELSA has shown that there is an extremely marked prevalence of carotid artery wall alterations among mild-to-moderate, middle-aged hypertensive patients. In addition to age, systolic blood pressure and pulse pressure, particularly if they are accurately measured by ambulatory monitoring, play a major role, somewhat greater than those of sex, low-density lipoprotein cholesterol concentration and smoking, in influencing intima-media thickness.

Original languageEnglish
Pages (from-to)949-961
Number of pages13
JournalJournal of Hypertension
Volume16
Issue number7
DOIs
Publication statusPublished - 1998

Keywords

  • Atherosclerosis
  • Blood pressure
  • Carotid artery
  • Intima-media thickness
  • Lacidipine
  • Ultrasound imaging

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology

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    Zanchetti, A., Bond, M. G., Hennig, M., Neiss, A., Mancia, G., Dal Palù, C., Hansson, L., Magnani, B., Rahn, K. H., Reid, J., Rodicio, J., Safar, M., Eckes, L., Ravinetto, R., Zanchetti, A., Bond, M. G., Dal Palù, C., Hansson, L., Hennig, M., ... Lister, E. C. (1998). Risk factors associated with alterations in carotid intima-media thickness in hypertension: Baseline data from the European Lacidipine Study on Atherosclerosis. Journal of Hypertension, 16(7), 949-961. https://doi.org/10.1097/00004872-199816070-00008