The VHAS (Verapamil-Hypertension Atherosclerosis Study) Investigators entered 1464 patients with essential hypertension and blood pressure (BP) values > or = 160 mmHg systolic and 95 mmHg diastolic (DBP) but excluded those with a DBP > or = 115 mmHg, and those with diabetes mellitus or previous myocardial infarction or cerebrovascular episodes. Patients were randomly allocated to drug therapy for 2 years with either slow-release verapamil 240 mg once daily or chlorthalidone 25 mg once daily, with nonresponders receiving additional captopril 25 mg daily. A random group of eligible patients (n = 494) was followed for a more extended period (4 years) using beta-mode ultrasound. The end point is the development of atherosclerosis detected by ultrasound imaging. The most interesting observation thus far is that in this population of middle-aged hypertensives without a history of previous cardiovascular events, about two thirds had asymptomatic carotid alterations. The study is ongoing.