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Comparison of the effects of antihypertensive treatment with angiotensin II blockade and beta-blockade on carotid wall structure and haemodynamics: protocol and baseline demographics
Ben Ariff
Department of Clinical Pharmacology & Therapeutics, St Mary's Hospital, Imperial College, London, UK, b.ariff{at}ic.ac.uk
Alice Stanton
Department of Clinical Pharmacology, Royal College of Surgeon's, Dublin, Ireland
Dean Barratt
Department of Clinical Pharmacology & Therapeutics, St Mary's Hospital, Imperial College, London, UK
Alex Augst
Department of Chemical Engineering, Imperial College, London, UK
Fadi Glor
Department of Chemical Engineering, Imperial College, London, UK
Neil Poulter
Department of Clinical Pharmacology & Therapeutics, St Mary's Hospital, Imperial College, London, UK
Peter Sever
Department of Clinical Pharmacology & Therapeutics, St Mary's Hospital, Imperial College, London, UK
Yun Xu
Department of Chemical Engineering, Imperial College, London, UK
Alun Hughes
Department of Clinical Pharmacology & Therapeutics, St Mary's Hospital, Imperial College, London, UK
Simon AMcG Thom
Department of Clinical Pharmacology & Therapeutics, St Mary's Hospital, Imperial College, London, UK
Several systemic factors have been shown to contribute to the acceleration of large vessel atheroma. Correction of these factors leads to a reduction in the progression of plaque formation and associated arterial wall thickness. Atheroma remains, however, a focal disease, developing at characteristic sites within the arterial tree. These sites are typically at areas of vessel branching or marked curvature, and correspond to regions of high tensile stress and low sheer stress, leading to the hypothesis that local haemodynamic factors and vessel wall mechanics potentiate the focal development of atheroma.
Current assessment of vascular haemodynamics suffers from an inability to handle complex flow, and does not allow accurate determination of locally varying flow, and shear stress patterns. The application of computational fluid dynamic (CFD) flow simulation techniques to ultrasound and local pressure data, however, allows a comprehensive, non-invasive appraisal of haemodynamic flow parameters to be performed.
The Candesartan cilexetil and Atenolol Carotid Haemodynamic Endpoint Trial (CACHET) study compares the effects of two antihypertensive regimens, one β-blocker-based, the other angiotensin receptor blocker based, on carotid intima-media thickness. The collection of ultrasound and pressure data on each subject provides a unique opportunity to apply these data to the CFD model to study the effects of these antihypertensive regimens on local fluid dynamics. This will lead to a greater understanding of the relationship of these factors to atheroma formation and regression.
Key Words: candesartan cilexetil • carotid haemodynamics • intima-media thickness
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Journal of Renin-Angiotensin-Aldosterone System, Vol. 3, No. 2,
116-122 (2002)
DOI: 10.3317/jraas.2002.012
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