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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1996;16:462-470.)
© 1996 American Heart Association, Inc.

Articles

Multiple Risk Intervention in High-Risk Hypertensive Patients

A 3-Year Ultrasound Study of Intima-Media Thickness and Plaques in the Carotid Artery

Madis Suurküla; Stefan Agewall; Björn Fagerberg; Inger Wendelhag; John Wikstrand; on behalf of the Risk Intervention Study (RIS) Group¹

From the Department of Clinical Physiology, Institute of Heart and Lung Diseases (M.S.) Hypertension Unit, Department of Internal Medicine (S.A., B.F.), and Wallenberg Laboratory for Cardiovascular Research (I.W., J.W.), Sahlgrenska Hospital, Göteborg University, Gothenburg, Sweden.

Correspondence to Prof John Wikstrand, Wallenberg Laboratory, Göteborg University, Sahlgrenska Hospital, S-413 45 Gothenburg, Sweden.

Abstract In spite of optimal blood pressure control, available data indicate that the risk of coronary heart disease remains high in many patients with hypertension. Multifactorial risk intervention programs have therefore been advocated. The aim of the present randomized study was to analyze whether a favorable change in risk factors caused by a comprehensive risk factor modification program (focused mainly on nonpharmacological intervention) might beneficially affect ultrasound-assessed far-wall common carotid intima-media thickness or plaques in the carotid artery in high-risk hypertensive patients (n=81) in comparison with those undergoing usual care (n=83). A further aim was to analyze whether risk factors measured at baseline or follow-up were related to the change recorded in intima-media thickness during follow-up. The results showed in the intervention group a favorable change in LDL cholesterol (-9%), in smoking habits (32% of smokers quit smoking), and in HbA_1c (-17% in patients with diabetes mellitus) over the 3.5-year observation period. However, no difference between the two randomization groups could be observed for far-wall common carotid intima-media thickness or plaque status during follow-up. Of all tested potential risk factors, only fasting insulin at baseline (available in nondiabetic patients) was significantly related to the change in mean intima-media thickness during follow-up (r=.25, n=92, P<.01). The relationship (negative) between follow-up serum HDL and change in mean intima-media thickness during the preceding follow-up was of borderline significance. Patients with moderate to large plaques in the carotid artery region at baseline had a significantly larger increase in common carotid artery intima-media thickness during follow-up than patients with no or only small plaques. The results are disappointing and may indicate that either the change in risk factors occurred too late in life or a considerably larger change in concomitant risk factors than we observed is needed to favorably affect intima-media thickness during an observation period of around 3 years in high-risk hypertensive patients.

Key Words: atherosclerosis • hypertension • risk factors • prevention • ultrasound

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