Antihypertensive therapy and regression of coronary artery disease: Insights from the Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) and Norvasc for Regression of Manifest Atherosclerotic Lesions by Intravascular Sonographic Evaluation (NORMALISE) trials

• Published in: The American heart journal Vol. 152; no. 6; pp. 1059 - 1063
• Main Authors: Brener, Sorin J., Ivanc, Thomas B., Poliszczuk, Roman, Chen, Michael, Tuzcu, E. Murat, Hu, Tingfei, Frid, David J., Nissen, Steven E.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-12-2006; Elsevier; Elsevier Limited
• Subjects: Amlodipine - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - therapeutic use; Atherosclerosis; Atherosclerosis (general aspects, experimental research); Automation; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Calcium Channel Blockers - therapeutic use; Cardiology. Vascular system; Cardiovascular disease; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - drug therapy; Coronary heart disease; Coronary vessels; Drug therapy; Enalapril - therapeutic use; Female; Heart; Heart attacks; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - prevention & control; Randomized Controlled Trials as Topic; Software; Studies; Thrombosis - prevention & control; Treatment Failure; Ultrasonography, Interventional; Sonography; Evaluation; Therapy; Regression; Cardiovascular disease; Coronary heart disease; Knowledge; Phlebology; Thrombosis; Vascular disease; Treatment; Enalapril; Atherosclerosis; Echography; Amlodipine; Antihypertensive agent; Clinical trial; Circulatory system; Limit; Lesion; Cardiology; Comparative study
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2006.07.022

In patients with coronary artery disease (CAD), therapies designed to prevent clinical events are not always associated with significant reduction in coronary obstruction, as measured by quantitative coronary angiography. We set out to explore the relationship between quantitative coronary angiography parameters, baseline characteristics, and clinical events in a large trial of CAD regression with antihypertensive agents.
Patients randomized to amlodipine, enalapril, or placebo in the CAMELOT trial were followed for 24 months for major ischemic events. Among 431 patients participating in the angiographic and intravascular ultrasound substudy NORMALISE, 298 (99 amlodipine, 96 enalapril, and 103 placebo) had complete angiographic and intravascular ultrasound data. The patients did not differ significantly with respect to baseline characteristics (except for diabetes) or extent of CAD. After 24 months, the change in minimal lumen diameter (MLD) was −0.02 ± 0.13 for amlodipine, −0.03 ± 0.12 for enalapril, and −0.03 ± 0.17 mm for placebo (
P = .40). Major ischemic events occurred in 20.2%, 24%, and 25.2%, respectively (
P = .68). There was no significant correlation between change in MLD and age, sex, statin therapy, or systolic blood pressure at baseline. The change in MLD did not differ in patients with and without cardiovascular events, regardless of treatment assignment (
P = .54). Only the extent of CAD was independently predictive of ischemic events.
As compared to placebo, amlodipine treatment resulted in fewer ischemic events after 24 months of therapy, but the clinical benefit was not associated with a commensurate improvement in arterial lumen dimensions.