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To the Editor: In their article on the effects of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure, Dr Nissen and colleagues¹ found that the amlodipine group had both a significant decrease in cardiovascular events and a slower progression of coronary atherosclerosis as assessed by intravenous ultrasound (IVUS). We have some concerns about the study.

First, since no data on the mode of enrollment of patients in the IVUS substudy are provided, the likelihood of selection bias cannot be judged.

Second, the IVUS data in the amlodipine group should be compared with those in the Reversal of Atherosclerosis With Aggressive Lipid Lowering (REVERSAL) trial following equivalent methods.² The nominal change in percentage atheroma volume (PAV) of 0.5% in the amlodipine group (83% of whom were taking statins) is comparable with the 0.6% change in PAV in the 80-mg atorvastatin group in the REVERSAL trial, . . . [Full Text of this Article]

Victor Aboyans, MD, PhD
aboyans@unilim.fr

Philippe Lacroix, MD
Vascular Unit
Department of Thoracic and Cardiovascular Surgery

Claude Cassat, MD
Department of Cardiology
Dupuytren University Hospital
Limoges, France

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