Early detection of silent ischemia and diastolic dysfunction in asymptomatic young hypertensive patients

Background: There is an association between coronary artery disease (CAD) and increased carotid‐intima media thickness (IMT), a surrogate index of atherosclerosis. This association is poorly studied in asymptomatic subjects with risk factors of CAD. Aim: To study the relationship between carotid‐IMT, coronary flow reserve (CFR) and cardiac function in asymptomatic young hypertensive subjects. Methods: This study includes 82 asymptomatic young subjects with essential hypertension, and 78 healthy control subjects. Carotid‐IMT was assessed with B‐mode ultrasonography. Treadmill exercise test, CFR and echo Doppler study were performed for all subjects. Results: Hypertensive group had a significantly higher carotid‐IMT (0.91 + 0.13 vs. 51 ± 0.09, P < 0.01), and a significantly lower coronary flow velocity reserve (1.9 ± 0.44 vs. 3.2 ± 0.44, P < 0.003) than in control subjects, especially in those with stress induced myocardial ischemia. Multiple linear regression analyses shows that increased carotid‐IMT was related to a reduced CFR (r = ? 843, P < 0.001) and a lower diastolic function (E/e″, r = ? 512, P < 0.003) in asymptomatic hypertensives. In addition the carotid‐IMT showed a significant correlation with family history of hypertension in these subjects (r = 653, P < 0.002). Conclusion: Carotid‐IMT increases significantly in asymptomatic young hypertensive patients. It has a relationship with stress‐induced myocardial ischemia, decrease CFR and incipient diastolic dysfunction in those patients. It could be considered as an index for subclinical atherosclerosis and diastolic dysfunction in asymptomatic subjects with risk factors for CADs. (Echocardiography 2011;28:564‐569)