Carotid remodeling in essential hypertension: role of blood pressure, indexed parameters, and association with cardiac mass and aortic stiffness

The role of blood pressure on carotid remodeling, using no indexed and indexed parameters, was studied in essential hypertension. Carotid parameters were also compared to cardiac mass and aortic stiffness. Forty untreated hypertensive men had echocardiography, carotid ultrasonography and carotidfemoral pulse wave velocity measurements. Cross-sectional area index was associated essentially with the 24-hour systolic blood pressure whereas intima-media thickness was related especially to the 24-hour pulse pressure. Carotid intima-media thickness and cross-sectional area indexes were less related to blood pressure variables than non-indexed parameters. There is an independent association between 24-hour pulse pressure and left ventricular mass index and pulse wave velocity. To conclude, blood pressure, particularly pulse pressure, is associated with vascular and cardiac alterations. The indexation by the body surface area do not provide any additional information in the association between carotid and blood pressure parameters.     

Different effects of atherogenic lipoproteins and blood pressure on arterial structure and function: the Bogalusa Heart Study

Differential impact of non-high-density lipoprotein cholesterol (total cholesterol minus high-density lipoprotein cholesterol) and blood pressure on arterial wall thickness and stiffness was examined in 900 black and white adults aged 24-43 years. Blacks compared with whites had greater values of pulse wave velocity (5.4 m/sec vs. 5.2 m/sec; p<0.01) and carotid artery intima-media thickness (0.83 mm vs. 0.80 mm; p<0.01). Non-high-density lipoprotein cholesterol was significantly associated with carotid intima-media thickness (standardized regression coefficient [b]=0.21; p<0.01), but not with pulse wave velocity (b=0.03; p=0.37), after adjusting for race, sex, age, body mass index, insulin, glucose, and smoking. Systolic blood pressure was associated significantly stronger with pulse wave velocity (b=0.36; p<0.01) than with carotid intima-media thickness (b=0.15; p<0.01). No race difference in these relationships was found. The results of this study indicate that atherogenic lipoproteins and blood pressure may play different roles in the development of arterial wall stiffness and atherosclerosis.     

Gender-specific brachial artery blood pressure-independent relationship between pulse wave velocity and left ventricular mass index in a group of African ancestry

AIM: As it is uncertain whether arterial stiffness is related to left ventricular mass and left ventricle mean wall thickness independent of blood pressure measured at the brachial artery, we aimed to ascertain this effect in never-treated participants with a high prevalence of risk factors for large artery dysfunction. METHODS: The conventional and ambulatory blood pressure-independent relations between indices of large artery function and either left ventricular mass or mean wall thickness were determined in 309 never-treated randomly recruited South Africans of African ancestry with prevalent risk factors for large artery changes [24% were hypertensive, 63% were overweight/obese, and 17% had diabetes mellitus or abnormal blood glucose control (glycosylated hemoglobin A1c > 6.1%)]. Large artery function was assessed from applanation tonometry performed at the carotid, radial and femoral arteries and central augmentation index and aortic pulse wave velocity (carotid femoral pulse wave velocity) derived from these measures. Left ventricular mass indexed for height (left ventricular mass index) and mean wall thickness were determined using echocardiography. RESULTS: Pulse wave velocity was associated with left ventricular mass index (r = 0.67, P < 0.0001) and mean wall thickness (r = 0.61, P < 0.0001) in women, but not in men (r = 0.04-0.08) (P < 0.0001 for the interaction between pulse wave velocity and gender). On multivariate analysis with appropriate adjustments including either conventional systolic blood pressure, pulse pressure or mean arterial pressure, pulse wave velocity was independently associated with left ventricular mass index (partial r = 0.25, P < 0.005 after adjustments for systolic blood pressure) and with mean wall thickness (partial r = 0.17, P < 0.05 after adjustments for systolic blood pressure) in women, but not in men. With the inclusion of 24-h ambulatory rather than conventional systolic blood pressure, pulse pressure or mean arterial pressure in the regression equation, pulse wave velocity was similarly independently associated with left ventricular mass index (partial r = 0.39, P < 0.001 after adjustments for 24-h systolic blood pressure) and mean wall thickness (partial r = 0.33, P < 0.003 after adjustments for 24-h systolic blood pressure) in women, but not in men. Central augmentation index was not independently associated with left ventricular mass index or mean wall thickness. In women, the contribution of pulse wave velocity to left ventricular mass index or mean wall thickness independent of systolic blood pressure (standardized beta-coefficient for left ventricular mass index=0.37 +/- 0.13, P < 0.005) was equivalent to the contribution of systolic blood pressure (standardized beta-coefficient for left ventricular mass index = 0.38 +/- 0.13, P < 0.005). Moreover, after adjusting for clinic or ambulatory systolic blood pressure and other confounders, in women every one standard deviation increase in pulse wave velocity (2.1 m/s) translated into a 4.3 or 6.2 g/m increase in left ventricular mass index, respectively. CONCLUSION: Arterial stiffness is associated with left ventricular mass index and left ventricle wall thickness independent of conventional or ambulatory blood pressure and additional confounders in a never-treated population sample of women, but not men, of African ancestry with prevalent risk factors for large artery dysfunction.     

Association of pulse pressure with carotid atherosclerosis in patients with type 2 diabetes mellitus

Pulse pressure is known to be a potent risk factor for cardiovascular disease. However, it has not been determined whether pulse pressure is associated with cerebrovascular disease in patients with diabetes mellitus. The purpose of the present study was to investigate association of pulse pressure with carotid atherosclerosis in patients with diabetes and to determine whether age and gender affect the association. A cross-sectional study was performed using outpatients with type 2 diabetes. Carotid atherosclerosis and arterial stiffness were evaluated by intima-media thickness of common carotid arteries (IMT) and aortic pulse wave velocity (a-PWV), respectively. The relationship of brachial pulse pressure with IMT was analyzed. Pulse pressure was significantly correlated with age, duration of diabetes, systolic blood pressure, serum sialic acid, a-PWV and IMT. The mean IMT in the highest tertile group of pulse pressure after adjustment for gender was significantly higher than the mean IMT in the lowest tertile group. In analysis using subgroups of gender, a significant correlation between pulse pressure and IMT was shown in women but not in men. In multiple regression analysis, there was a significant correlation between pulse pressure and IMT in women independently of age, body mass index, systolic blood pressure, hemoglobin A1c, atherogenic index, a-PWV, history of therapy for hypertension and history of nephropathy. The results of this study suggest that pulse pressure is a major age-independent predictor of carotid atherosclerosis in female patients with diabetes.     

颈动脉内中膜厚度与脉搏波传导速度及踝臂指数的相关性研究

目的:前瞻性研究颈动脉内中膜厚度(IMT)与脉搏波传导速度(PWV)及臂踝血压指数(ABI)的相关性。方法:在115例(女61)人群资料中用超声测量颈IMT,用日本科林动脉硬化测定仪测量臂踝PWV和臂踝ABI,同时测定血TC、TG、HDL、LDL、空腹血糖(FBG)、血尿酸(UA)、体质指数(BMI)等,作均数比较、t检验,IMT与各因素的简单相关分析、多元线性回归分析(进入法和逐步法)。结果:115例受检者颈IMT平均值为:(0.64±0.11)mm,男性颈动脉IMT明显高于女性,年龄≥50岁组的颈动脉IMT明显高于年龄<50岁组的,收缩压≥140mmHg(1mmHg=0.133kPa)组的颈动脉IMT明显高于收缩压<140mmHg组的,有高血压病史组的颈动脉IMT明显高于无高血压病史组的。颈动脉IMT主要与年龄、臂踝PWV、收缩压、ABI等正相关,相关系数分别达0.625、0.460、0.412、0.361。多元回归分析,对颈动脉IMT有独立影响的因素是年龄、SBP。结论:颈动脉IMT与臂踝PWV、ABI高度正相关,在临床工作中可根据各自条件选择一种检查方法用于血管早期病变的检测。     

老年人脉搏波速度与颈动脉内膜厚度的相关性

目的 分析老年人臂踝脉搏波速度(baPWV)与颈动脉内膜-中层厚度(IMT)的相关性.方法 选择年龄60～89岁、平均(71±6)岁人员为研究对象,共纳入450例,其中男性234例,女性216例.所有受检对象均签署知情同意书,进行baPWV、IMT、身高、体质量、腰围、血压、心率等一般指标的检测.分析baPwV与颈动脉...     

Carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with and without coronary artery disease

BACKGROUND: Carotid intima-media thickness and pulse wave velocity are non-invasive markers of atherosclerosis and have been shown to reliably predict presence and extent of atherosclerotic vascular disease. However, studies examining their association with each other have shown inconsistent results. Hence it was sought to assess correlation between carotid intima-media thickness and pulse wave velocity in patients with and without coronary artery disease. METHODS AND RESULTS: Sixty-four patients with angiographically proven coronary artery disease and 84 age-matched individuals without coronary artery disease but having one or more conventional cardiovascular risk factors were included in the study. Individuals with established cerebrovascular disease and peripheral vascular disease were excluded from the study. Carotid intima-media thickness of far wall was measured at three predefined sites (distal common carotid, carotid bifurcation and proximal internal carotid artery) on each side. Brachial-ankle pulse wave velocity was measured non-invasively using VP 1000 (Colin Corporation) automated ABI/ PWV analyzer. There was no significant difference in gender and presence of cardiovascular risk factors in the two groups. Mean and maximum carotid intima-media thickness and brachial-ankle pulse wave velocity were all significantly higher in coronary artery disease patients as compared to patients without coronary artery disease (0.842 v. ( 0.657 mm, p <0.0001; 1.076 v. 0.795 mm, p <0.0001; 1708.63 v. 1547.26 cm/s, p <0.0004 respectively). There was a significant correlation between brachial-ankle pulse wave velocity and both mean and maximum carotid intima-media thickness in patients with coronary artery disease (r = 0.47, p <0.0001 and r=0.41, p < 0.0008 respectively) but not in individuals without coronary artery disease (r=0.01 and -0.1 respectively). CONCLUSIONS: Presence of significant correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with coronary artery disease but absence of the same in individuals without major atherosclerotic vascular disease suggests that the correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity becomes stronger with increasing extent of atherosclerosis.     

Prognostic Value of Direct, Continuous Ambulatory Blood Pressure Monitoring in Essential Hypertension

This study assessed the prognostic value of ambulatory vs. clinic blood pressure measurement in 688 hypertensives who had undergone pretreatment 24-hour intra-arterial ambulatory blood pressure monitoring. A total of 157 first events were recorded over a follow-up period of 9.2±4.4 years. Ambulatory systolic or diastolic blood pressure parameters (whether 24-hour mean, daytime mean, or nighttime mean) or ambulatory pulse pressure provided independent prognostic information in conjunction with clinical variables. The most predictive models contained the ambulatory systolic blood pressure parameters. Age, male gender, South Asian origin, diabetes mellitus, and previous cardiovascular disease were additional independent predictors of events. In a subgroup of 295 uncomplicated patients, 24-hour ambulatory pulse pressure was an independent predictor of left ventricular mass index and maximal carotid intima-media thickness. Baseline clinic blood pressure parameters did not provide independent information for the prediction of events or target organ damage. Therefore, in this study, ambulatory blood pressure proved to be superior to clinic measurement for cardiovascular risk stratification. However, the routine use of ambulatory blood pressure monitoring is not currently recommended, mainly because of a lack of outcome trials based on the treatment of ambulatory blood pressure levels.     

高血压病患者动态脉压与颈动脉粥样硬化关系的研究

为了探讨动态脉压与颈动脉粥样硬化之间的关系 ,将 172名高血压病人分为两组 ,2 4h平均脉压在 40～ 5 5mmHg者为一组 ,2 4h平均脉压 >5 5mmHg者为一组。所有病人同时经超声检测颈总动脉、颈内动脉和颈动脉分叉处的内膜中层厚度、血管内径及斑块发生率 ,并以颈总动脉最大内膜中层厚度作为评价颈动脉粥样硬化程度的指标。结果观察到 ,在同一平均动脉压水平下 ,脉压 >5 5mmHg者颈总动脉内径、颈总动脉最大内膜中层厚度及粥样斑块发生率均明显大于脉压为 40～ 5 5mmHg者 (P <0 .0 0 1)。Pearson相关分析显示平均脉压、年龄、平均收缩压、高血压病程与颈总动脉最大内膜中层厚度呈明显正相关 (r =0 .5 40 ,r=0 .470 ,r =0 .44 3 ,r =0 .2 31,P <0 .0 0 1) ,而平均舒张压与颈总动脉最大内膜中层厚度呈负相关 (r=- 0 .2 8,P <0 .0 5 )。逐步回归分析表明 ,夜间脉压、年龄与颈动脉粥样硬化独立相关。研究结果提示 ,动态脉压是颈动脉粥样硬化发展中的重要参数 ,可作为评估颈动脉粥样硬化程度的有效指标。     

Carotid plaques, but not common carotid intima-media thickness, are independently associated with aortic stiffness.

OBJECTIVE: It has been suggested that non-invasive aortic stiffness measurements can be used as an indicator of atherosclerosis. The relationships of arterial stiffness with arterial wall hypertrophy and atherosclerosis however, have rarely been investigated in large-scale studies. The present study reports the associations of carotid arterial structure assessed by B-mode ultrasound with carotid-femoral pulse-wave velocity in hypertensive and non-hypertensive subjects. DESIGN AND METHODS: Free health examinations were performed on 564 subjects (age 58.2 +/- 10.8 years, 31.9% of women, 53.2% of all were hypertensive). Carotid-femoral pulse-wave velocity (PWV) was used to assess aortic stiffness. Carotid ultrasound examination included measurements (at sites free of plaques) of intima-media thickness (IMT) at the common carotid arteries (CCA), CCA-lumen diameter, and assessment of atherosclerotic plaques in the extracranial carotid arteries. RESULTS: Subjects with carotid plaques had significantly higher mean sex-adjusted values of PWV than those without carotid plaques (12.7 +/- 0.2 versus 11.1 +/- 0.1 m/s, P < 0.001). Multivariate analyses showed that this association was independent of sex, age, height, body mass index, mean blood pressure, pulse pressure, diabetes, hypercholesterolaemia and smoking habits (P < 0.009). PWV was positively associated with CCA-IMT and CCA-lumen diameter in sex-adjusted analysis (partial correlation coefficients (r ) were respectively 0.39 and 0.42, P < 0.001 for each). However, the association of PWV with CCA-IMT, but not that with CCA-lumen diameter, disappeared after further adjustment for age and blood pressure measurements (mean blood pressure and/or pulse pressure). CONCLUSION: This study shows that there is a differential association of PWV with CCA-IMT and carotid plaques. The nature of the independent positive association between atherosclerosis and arterial stiffness should be thoroughly investigated.     

Endogenous nitric oxide synthase inhibitors, arterial hemodynamics, and subclinical vascular disease: the PREVENCION Study

Endogenous NO synthase inhibitors (end-NOSIs) have been associated with cardiovascular risk factors and atherosclerosis. In addition, end-NOSIs may directly cause hypertension through hemodynamic effects. We aimed to examine the association between end-NOSI asymmetrical dimethylarginine (ADMA) and N-guanidino-monomethyl-arginine (NMMA), subclinical atherosclerosis, and arterial hemodynamics. We studied 922 adults participating in a population-based study (PREVENCION Study) and examined the correlation between end-NOSI/L-arginine and arterial hemodynamics, carotid-femoral pulse wave velocity, and carotid intima-media thickness using linear regression. ADMA, NMMA, and L-arginine were found to be differentially associated with various classic cardiovascular risk factors. ADMA and NMMA (but not L-arginine) were significant predictors of carotid intima-media thickness, even after adjustment for cardiovascular risk factors, C-reactive protein, and renal function. In contrast, ADMA and NMMA did not predict carotid-femoral pulse wave velocity, blood pressure, or hemodynamic abnormalities. Higher L-arginine independently predicted systolic hypertension, higher central pulse pressure, incident wave amplitude, central augmented pressure, and lower total arterial compliance but not systemic vascular resistance or cardiac output. We conclude that ADMA and NMMA are differentially associated with cardiovascular risk factors, but both end-NOSIs are independent predictors of carotid atherosclerosis. In contrast, they are not associated with large artery stiffness, hypertension, or hemodynamic abnormalities. Our findings are consistent with a role for asymmetrical arginine methylation in atherosclerosis but not in large artery stiffening, hypertension, or long-term hemodynamic regulation. L-arginine is independently associated with abnormal pulsatile (but not resistive) arterial hemodynamic indices, which may reflect abnormal L-arginine transport, leading to decreased intracellular bioavailability for NO synthesis.     

2型糖尿病患者颈动脉硬化斑块形成的相关因素分析

目的 探讨2型糖尿病患者颈动脉硬化斑块形成的相关因素.方法 123例2型糖尿病患者,根据颈动脉彩色超声结果分为颈动脉无硬化斑块组、颈动脉硬化斑块组,分别检测各组血清C反应蛋白、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血浆致动脉硬化指数、血尿酸、血肌酐,并记录年龄、糖尿病病程、体重指数、收缩压、舒张压、脉压差、吸烟史、高血压史、微血管并发症、颈动脉内膜厚度等指标,进行统计学处理.结果 颈动脉硬化斑块组中年龄(P<0.01)、C反应蛋白(P<0.05)、颈动脉内膜厚度(P<0.01)以及微血管并发症发生率(P<0.05)均比颈动脉无硬化斑块组显著增高,差别均有统计学意义.Logistic回归分析显示,颈动脉内膜厚度与颈动脉硬化斑块形成独立相关(P<0.05).结论 2型糖尿病患者颈动脉硬化斑块形成与颈动脉内膜厚度、年龄、C反应蛋白等多因素有关,颈动脉内膜厚度增加是颈动脉硬化斑块形成的危险因素,颈动脉硬化斑块形成的同时微血管并发症的发生率增加.     

高血压病人颈动脉粥样硬化与胰岛素抵抗关系的探讨

目的　探讨胰岛素抵抗及高胰岛素血症与高血压病人颈动脉粥样硬化的关系。方法　选择原发性高血压病人 84例 ,分成颈动脉粥样硬化组 (CA组 )和颈动脉正常组 (NC组 )。应用高分辨率 B型超声测定颈动脉参数。应用胰岛素敏感指数 (ISI)评估胰岛素抵抗程度。结果　 CA组的胰岛素 (INS)、颈动脉内膜 -中层厚度 (IMT)、粥样硬化斑块积分 (PS)显著高于 NC组 (P<0 .0 5 ) ,CA组的 ISI显著低于 NC组 (P<0 .0 5 )。 IMT与血糖 (SG)、INS呈正相关 (P<0 .0 1) ,IMT与 ISI呈负相关 (P<0 .0 1)。 PS与 SG、INS呈正相关 ,PS与 ISI呈负相关 (P<0 .0 1)。多元逐步回归分析显示 :年龄、SG、ISI、收缩压 (SBP)与 IMT相关性较为密切 ,其标准回归系数分别为 0 .2 2 2、0 .739、- 1.12 5、0 .116。 INS、体重指数(BMI)、脉压 (PP)与 PS相关性较为密切 ,其标准回归系数分别为 0 .5 5 4、- 0 .2 2 1、0 .141。结论　胰岛素抵抗与高血压病人颈动脉内膜 -中层厚度增厚及粥样硬化斑块形成密切相关     

Cardiac structural and functional changes during long-term antihypertensive treatment with lacidipine and atenolol in the European Lacidipine Study on Atherosclerosis (ELSA)

OBJECTIVES: To evaluate and correlate the effects of long-term antihypertensive treatment on left ventricular (LV) mass and carotid structural changes in a large group of essential hypertensive patients, participating in the European Lacidipine Study on Atherosclerosis (ELSA). DESIGN: In four (Brescia, Glasgow, Naples and Pisa) of 23 centres participating in the ELSA study, an echocardiographic examination was performed at baseline and repeated, until the end of the 4-year study, in essential hypertensive patients, followed-up for carotid quantitative ultrasound examination of intima-media thickness (IMT), after random allocation to treatment with either lacidipine or atenolol (and added hydrochlorothiazide, as required for control of blood pressure). METHODS: M-mode, two-dimensional guided echocardiography was used to measure left ventricular (LV) wall thickness and dimensions, from which LV mass was calculated, using an anatomically validated formula (Penn Convention) and indexed to body surface area (left ventricular mass index, LVMI). The echocardiographic tracings were blindly evaluated in a single reading centre (Brescia). Bilateral IMT was measured at the site of common carotid and bifurcation far walls (CBMmax). RESULTS: At baseline, cardiac and carotid ultrasound scans were available in 278 patients (mean age 54 +/- 7 years, 57% males, 22% obese). A significant correlation was observed between baseline LVMI and CBMmax (r = 0.22, P < 0.001), independent of age. In multivariate analysis, CBMmax and mean 24-h pulse pressure were most strongly associated with baseline LVMI. A significant reduction in LVMI was observed both during lacidipine (n = 96) (-12.5% reduction) and atenolol (n = 78) (-13.9% reduction) treatments (up to 4 years) (P < 0.001 for both, without significant differences between treatments). Changes in LVMI were not related to changes in carotid wall thickness. In multivariate analysis, baseline LV mass and mean 24-h systolic blood pressure changes were significantly associated with changes in LV mass. CONCLUSIONS: In this large, long-term controlled study, antihypertensive treatment with atenolol or lacidipine was accompanied by a similar and significant decrease in LV mass. Treatment-induced changes in LV mass were related to baseline LV mass and changes in 24-h mean systolic blood pressure, without any correlation with changes in carotid structure. In the whole ELSA population, carotid IMT changes have been shown to be unrelated to blood pressure reduction, but significantly influenced by the type of antihypertensive treatment.     

Pulse pressure in normotensives: a marker of cardiovascular disease

The purpose of the present study was to evaluate the relation of the systemic arterial pulse pressure and other parameters derived from the 24-h arterial blood pressure (BP) monitoring to the severity of coronary artery disease, carotid lesions, and left ventricular (LV) mass index in patients without arterial hypertension. One hundred ten patients with known coronary artery disease underwent coronary arteriography, 24-h arterial BP monitoring, and ultrasound imaging of the carotid arteries and the myocardium. Measurements of 24-h arterial BP monitoring (systolic, diastolic, and average BP, pulse pressure, abnormal values of systolic and diastolic BP, and heart rate), the severity of coronary heart disease (Gensini score), intima-media thickness (IMT) of the common carotid artery and LV mass index were determined in all patients. By univariate analysis, only 24-h pulse pressure was significantly related to the severity of coronary artery disease (P < .01), carotid IMT(P < .01), and LV mass index (P < .01). In a multivariate analysis, 24-h pulse pressure was also the best predictor of the severity of coronary lesions (P = .009), carotid IMT (P = .003), and LV mass index (P = .009). Gensini score was related (P < .01) to LV mass index and not to carotid IMT. In conclusion, systemic arterial pulse pressure derived from 24-h arterial BP monitoring is related to coronary artery disease, carotid IMT, and LV mass index independently of age or any other derivative of 24-h arterial BP monitoring, indicating that this parameter could be a marker of global cardiovascular risk.     

Is cardiovascular reactivity associated with atherosclerosis among hypertensives?

Exaggerated cardiovascular reactivity to behavioral challenges among otherwise healthy individuals has been associated with carotid atherosclerosis. We evaluated whether a similar relationship exists among hypertensives, who are at a heightened atherosclerotic risk. Untreated, hypertensive men (n=251; age range, 40 to 70 years; 197 white, 54 black) completed a standardized battery of behavioral challenges while their blood pressure responses to the battery were measured. Mean and maximum carotid intima-media thickness and the occurrence of carotid plaques were subsequently determined using B-mode ultrasonography. Although greater systolic and diastolic responses to the battery were associated with greater mean and maximum intima-media thickness in univariate analyses (P<0.01), only diastolic reactivity showed a unique association with mean and maximum carotid intima-media thickness after multivariate adjustment for age, race, socioeconomic status, smoking and alcohol use, body mass index, lipid profile, glucose and insulin concentrations, and resting blood pressure (P<0.05). Carotid plaque occurrence was associated with greater systolic reactivity (P=0.05) and was marginally associated with greater diastolic reactivity (P=0.07) in univariate analyses, but neither systolic nor diastolic reactivity was uniquely associated with the presence of carotid plaques after multivariate risk-factor adjustment. Among hypertensives, exaggerated behaviorally evoked cardiovascular reactivity appears to be uniquely associated with greater carotid intima-media thickness but not with carotid plaque occurrence.     

Increased ambulatory arterial stiffness index is associated with target organ damage in primary hypertension

Increased arterial stiffness has been shown to predict cardiovascular mortality in patients with primary hypertension. Asymptomatic organ damage is known to precede cardiovascular events. We investigated the relationship between a recently proposed index of stiffness derived from ambulatory blood pressure (BP) and target organ damage in 188 untreated patients with primary hypertension. Ambulatory arterial stiffness index was defined as 1 minus the regression slope of diastolic over systolic BP readings obtained from 24-hour recordings. Albuminuria was measured as the albumin:creatinine ratio, left ventricular mass index was assessed by echocardiography, and carotid abnormalities were evaluated by ultrasonography. The prevalence of microalbuminuria, left ventricular hypertrophy (LVH), and carotid abnormalities was 12%, 38%, and 19%, respectively. Ambulatory arterial stiffness index was positively related to age, triglycerides, office and 24-hour systolic BP, 24-hour pulse pressure, urinary albumin excretion, and carotid intima-media thickness. Patients with microalbuminuria, carotid abnormalities, or LVH showed higher ambulatory arterial stiffness index as compared with those without it. After adjusting for confounding factors, each SD increase in ambulatory arterial stiffness index entails an &2 times higher risk of microalbuminuria, carotid abnormalities, and LVH and doubles the risk of the occurrence of >or=1 sign of organ damage. Ambulatory arterial stiffness index is associated with organ damage in patients with primary hypertension. These data strengthen the role of this index as a marker of risk and help to explain the high cardiovascular mortality reported in patients with high ambulatory arterial stiffness index.     

Higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis in end-stage renal disease.

Brachial-ankle pulse wave velocity is a new measure of arterial stiffness. We examined whether higher brachial-ankle pulse wave velocity is associated with more advanced carotid atherosclerosis and left ventricular hypertrophy in patients with end-stage renal disease, and whether this effect would be mediated by the influence of wave reflection on central arterial pressure. In 68 patients with end stage renal disease, we examined blood pressures, brachial-ankle pulse wave velocity and the augmentation index of the left common carotid artery, a measure of the impact of wave reflection on the systolic peak in central arteries. The degree of carotid atherosclerosis was quantified by a plaque score and maximum intimal-medial thickness. Echocardiography was used to determine the left ventricular mass index. In simple regression analysis, brachial-ankle pulse wave velocity was correlated with both plaque score and maximum intimal-medial thickness (r = 0.420, p < 0.001 and r = 0.452, p < 0.0005, respectively) but not with left ventricular mass index. Multiple regression analysis was performed with the plaque score or maximum intimal-medial thickness as the dependent variable and brachial-ankle pulse wave velocity and known clinical risk factors as the independent variables. The brachial-ankle pulse wave velocity was an independent risk factor for both plaque score (beta = 0.006, p = 0.004) and maximum intimal-medial thickness (beta = 0.008, p = 0.04). Independent risk factors for left ventricular mass index were left ventricular diastolic dimension (beta = 3.509, p = 0.000007) and augmentation index (beta = 0.580, p = 0.04). The brachial-ankle pulse wave velocity was unrelated to augmentation index in patients with end stage renal disease. In conclusion, higher brachial-ankle pulse wave velocity was found to be a risk factor for carotid atherosclerosis in patients with end-stage renal disease; this effect was independent of the influence of wave reflection on central arterial pressure. The brachial-ankle pulse wave velocity was unrelated to left ventricular structure.     

Carotid intima-media thickness is correlated with impairment of coronary flow reserve in hypertensive patients without coronary artery disease.

Hypertensive individuals occasionally experience angina-like chest pain despite having angiographically normal coronary arteries, and the etiology of this phenomenon has been suggested to be associated with depressed coronary flow reserve (CFR). Carotid intima-media thickness (IMT) assessed by ultrasound is correlated with not only cerebrovascular disease but also coronary artery disease and left ventricular hypertrophy (LVH). The aim of our study was to investigate the association between CFR and carotid IMT in patients with essential hypertension. We performed transthoracic Doppler recording of diastolic coronary flow velocity in the left anterior descending coronary artery at baseline and after maximal vasodilation by adenosine triphosphate infusion in 24 normotensive subjects and 125 hypertensive patients. CFR was defined as the ratio of hyperemic to basal averaged peak coronary flow velocity. Common cardiovascular risk factors, left ventricular mass index (LVMI), relative wall thickness (RWT), and carotid IMT were evaluated. The CFR of hypertensive patients (2.55 +/- 0.52) was significantly decreased compared with that of normotensive subjects (3.15 +/- 0.45). CFR showed a significant correlation with age, systolic blood pressure, RWT, and carotid IMT. Stepwise regression analysis revealed that, among carotid IMT, LVMI and RWT, only carotid IMT was a strong and independent parameter for predicting CFR in hypertensive patients. In conclusion, B-mode ultrasound scanning of the carotid artery seemed to be of clinical value in the screening of patients with LVH and impaired microcoronary circulation. These associations may explain the links between cardiac and cerebrovascular involvements in patients with hypertension.     

Relationships between vascular indexes and atherosclerotic risk factors in patients with type 2 diabetes mellitus

The relationships of cardio-ankle vascular index, (a new indicator of arterial stiffness), common carotid artery intima-media thickness, and ankle-brachial pressure index with atherosclerotic risk factors were compared in patients with type 2 diabetes. There were significant correlations between each pair of the above vascular indexes. Both cardio-ankle vascular index and intima-media thickness showed significant correlations with age, systolic blood pressure, pulse pressure, and serum total cholesterol. Ankle-brachial pressure index showed a significant negative correlation with pulse pressure but not with systolic blood pressure and total cholesterol. Logistic regression analysis showed that cardio-ankle vascular index and intima-media thickness were associated with systolic blood pressure and pulse pressure independently of age. These results suggest that there are significant associations among the 3 vascular indexes and that systolic blood pressure and pulse pressure are major, age-independent determinants of cardio-ankle vascular index and common carotid artery intima-media thickness in patients with diabetes.