Carotid intima-media thickness and plaque volume changes following 2-year angiotensin II-receptor blockade. The Multicentre Olmesartan atherosclerosis Regression Evaluation (MORE) study

Aim. The Multicentre Olmesartan atherosclerosis Regression Evaluation (MORE) study was a double-blind trial in patients with hypertension at increased cardiovascular risk with carotid wall thickening and a defined atherosclerotic plaque that used non-invasive 2- and 3-dimensional (D) ultrasound (US), to compare the effects of a 2-year treatment based on either olmesartan medoxomil or atenolol on common carotid (CC) intima-media thickness (IMT) and plaque volume (PV). Methods. A total of 165 patients (with systolic/diastolic blood pressure 140-180/90-105 mm Hg) were randomized to receive either olmesartan (20-40 mg/day) or atenolol (50-100 mg/day). US was performed at baseline and 28, 52 and 104 weeks. The primary efficacy outcome was the change from baseline (Delta) in CC-IMT assessed by 2D US. Secondary outcomes included Delta PV assessed by 3D US and blood pressure (BP). Results. Olmesartan and atenolol produced comparable significant reductions in CC-IMT; mean Delta IMT (SEM) was -0,090 (0,015) mm for olmesartan and -0,082 (0,014) mm for atenolol. Mean Delta PV was -4,4 (2,3) mu l and 0,1 (1,5) mu l in the olmesartan and atenolol treated subjects, respectively, without significant between-treatment differences. In the subgroup of patients with baseline PV >= median (33,7 mu l), significant between-treatment differences existed in Delta PV (p=0,023), because PV regressed significantly with olmesartan (Delta PV: -11,5 (4,4) mu l) but not with atenolol (Delta PV: 0,6 (2,5) mu l). In these patients BP reductions were comparable. Conclusion. Carotid IMT and BP decreased similarly with olmesartan and atenolol, but only olmesartan reduced the volume of larger atherosclerotic plaques.