Effect of Antihypertensive Therapy on Progression of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes Mellitus

Antihypertensive therapy reduces the incidence of cardiovascular events in people with diabetes mellitus (DM). However, the effects of treatment on subclinical atherosclerosis are less well studied. Results of a post hoc cohort analysis of the association between antihypertensive treatment and carotid artery intima-media thickness (CIMT) in the Troglitazone Atherosclerosis Regression Trial (TART), a randomized trial designed to evaluate the impact of troglitazone treatment on CIMT progression in adults with insulin-requiring type 2 DM, are reported. CIMT, blood pressure (BP), and use of antihypertensive agents were measured throughout the 2-year treatment period. In multivariable mixed-effects models, the annual rate of change in CIMT in relation to BP and duration of antihypertensive agent use, adjusting for covariates, was evaluated. Higher systolic BP was associated with a higher CIMT progression rate (p = 0.03). This association was reduced by antihypertensive treatment in a duration-dependent manner (p for interaction = 0.035). Adjustment for age, treatment assignment, and change in fasting glucose during the trial did not attenuate these associations. In conclusion, regular use of antihypertensive agents reduces the harmful impact of increased BP on atherosclerosis progression in patients with DM. The antiatherogenic effect of antihypertensive agents, including BP normalization and possible direct vascular wall protection, can be detected by CIMT progression using B-mode ultrasound in patients with DM.