Ultrasound evaluation of atherosclerotic manifestations in the carotid artery in high-risk hypertensive patients

Abstract

The aim of this study was to evaluate whether high-risk hypertensive patients (n=137) had larger far-wall common carotid artery intima-media thickness than a control group (n=37) and to study whether intima-media thickness was related to other signs of atherosclerotic disease. The results showed that intima-media thickness was significantly larger in the hypertension group than in the control group. Lumen diameter and mean cross-sectional area of the intima-media complex were larger both for hypertensive patients with a positive history of manifest clinical cardiovascular disease and for hypertensive patients with no such history than in the control group. There was a significant relationship between far-wall common carotid artery intima-media thickness and plaque status (visual scoring, no, small, moderate/large) in the carotid artery region. In univariate analyses, low diastolic blood pressure and high pulse pressure were both significantly related to plaque status. In multivariate analyses, pulse pressure was significantly and independently related both to common carotid artery intima-media thickness and to plaque status in the carotid artery region. In multivariate analyses, there was also an independent relationship between age and common carotid artery intima-media thickness, between smoking status and plaque status, and between a positive history of manifest clinical cardiovascular disease and plaque status. In conclusion, common carotid artery intima-media thickness and lumen diameter were increased in elderly high-risk hypertensive patients, in whom more than one third of the patients also had a moderate to large plaque in the carotid artery region. Moderate to large plaques showed a relatively strong relationship to manifest clinical cardiovascular disease and might thus be interpreted as an indicator of clinically more serious disease than an increase in common carotid artery intima-media thickness. Further studies are needed to investigate the value of common carotid artery intima-media thickness as a marker of carotid atherosclerosis and as a surrogate variable for coronary atherosclerosis.