The regression of vascular changes in hypertension - calcium channel blocker or angiotensin-converting enzyme inhibitor?

Recent advances in the understanding of vascular disease genesis suggest that atherosclerosis and hypertension are associated with changes in structural and functional parameters of vascular wall. Antihypertensive treatment decreases the rate of hypertension-related cardiovascular events and also reduces the development of atherosclerosis. Endothelial dysfunction is the early event that allows penetration of lipids and inflammatory cells into the arterial wall, contributing to the development of the atherosclerotic lesion. Agents that restore endothelial function have beneficial anti-atherogenic activities and can improve cardiovascular outcomes. This has been observed with angiotensin-converting enzyme inhibitors (ACEI) and certain dihydropyridine-type calcium channel blockers (CCB). Moreover, recent clinical trials have provided evidence that these classes of drugs can remodel the arterial smooth muscle cell membrane and inhibit the progression of atherosclerotic disease. There is evidence that ACEI and CCB exert an antiatherosclerotic action that is at least partly independent of the blood pressure-decreasing effect. An important question is whether ACEI and CCB - considered as the most effective antihypertensive agents with anti-atherogenic activities - affect atherosclerosis to a similar extent. Which therapy is more effective in reducing the progression of atherosclerotic lesions? This article summarizes our current thinking on the role of ACEI and CCB on atheroprotection in hypertensive patients. There are also presented numerous trials measuring the effects of ACEI and CCB on vascular wall characteristics especially on the intima-media thickness regarded as an early sign of atherosclerosis and sensitive predictor of future cardiovascular complications.