Early changes of the arterial carotid wall in uncomplicated primary hypertensive patients. Study by ultrasound high-resolution B-mode imaging.

Abstract

Arterial hypertension is frequently responsible for arteriosclerotic damage in the carotid region. Nevertheless, there is as yet no general agreement that hypertension is correlated with lesions detected by noninvasive means in the carotid arteries. We studied, by noninvasive echotomographic technique, 70 uncomplicated primary hypertensive individuals without clinically evident end-organ complications and 30 normotensive matched control subjects to detect early lesions of carotid arteries. The presence of other cardiovascular risk factors was assessed, and heart structure and function were studied by echocardiography. Although hypertensive individuals were comparable to control subjects for other risk factors, they showed a marked increase in the thickness of the intimal-medial complex of the carotid wall (0.71±0.4 versus 0.56±0.2 mm, P<.001 in the right carotid and 0.83±0.3 versus 0.58±0.2, P<.003 in the left), in left ventricular mass (203±52 versus 176±37 g, P<.05), and in the prevalence of definite plaques of the carotid wall, both monolaterally and bilaterally (P<.003 by A rterial hypertension is a well-recognized risk fac-/ \ tor for early degenerative lesions in the arterial JL \ . tree. Epidemiological studies have shown that high blood pressure (BP) levels are correlated with increased prevalence and incidence of coronary and cerebrovascular diseases. 16 Moreover, antihypertensive treatment has been found to reduce the incidence of stroke and myocardial infarction, although in the latter to a smaller extent. 715 The recent development of noninvasive techniques has allowed investigation of carotid arteries to detect early degenerative changes, to measure plaque dimension, and to follow the progression of arterial lesions. 16 In particular, measurement of the thickness of intimalmedial layers, which are portrayed as being limited by a pair of roughly parallel echogenic lines, has attracted the interest of several investigators. 17 Poli and coworkers 18 found that the thickness of the intimal-medial complex is increased in hypercholesterolemic patients, and Kawamori and coworkers 19 detected a similar finding in diabetic patients. Although there is still debate over whether the intimal plus medial thickening might be considered an initial arteriosclerotic lesion, it is X 1 test). Among the different factors contributing to the increase in thickness of the carotid artery wall, standing blood pressure, serum triglycerides, and age were found to be the best predictors (they accounted for about 16% of the variability, /><.OO5). These results indicate that carotid arteries of hypertensive individuals undergo degenerative changes, just as shown for hypercholesterolemic and diabetic patients in other studies. This supports the use of B-mode ultrasound imaging to detect early involvement of the carotid region before the appearance of any end-organ damage of hypertension. Moreover, this finding sheds new light on the relationship between arterial wall damage and insulin resistance, since all the main contributors ...

Serum cholesterol affects blood pressure regulation

“…30 To this purpose, it is useful to remember that BP and serum cholesterol levels are positively correlated with IMT in several studies. 17,35,36 This finding is also in agreement with the results of another study 37 which demonstrated in Chinese patients the role of hypertension, hypercholesterolaemia, and hypertrygliceridaemia in the pathogenesis of carotid atherosclerosis.…”

“…17 More recently 38 other authors stated that the relationship of BP variability with LV hypertrophy or carotid damage is controversial and this finding may further support the lack of correlation between ventricular hypertrophy and carotid damage.…”

Cardiac structure and function and arterial circulation in hypertensive patients with and without metabolic syndrome

“…11,12 This technique allows a high reproducibility of the measurements, as already shown in a previous study. 23 Peripheral artery assessment of significant atherosclerosis The resting ankle-brachial pressure index (ABPI) was measured with the subject in supine position with an 8-MHz continuous-wave Doppler probe. The value of the highest systolic blood pressure measured at the ankle was divided to the highest blood pressure measured in both arms.…”

Response

“…A previous report shows side-related differences in intima-media thickness of carotid arteries in primary hypertensive patients. 2 To evaluate the possibility of side-related influences on the relationship between overweight or obesity and carotid intima-media thickness, we performed a separate analysis for the right and left common carotid artery in our cohort of free-living middle-aged women. No side-related differences were detected in the mean values of common carotid intima-media thickness (right common carotid artery, 0.98Ϯ0.01; left common carotid artery, 0.97Ϯ0.01 [meanϮSE]).…”