Noninvasive study of arterial hypertension and carotid atherosclerosis.

Abstract

We noninvaslvely evaluated the prevalence and severity of atherosclerotic lesions of the internal carotid artery in 146 nonobese, nondiabetic hypertensive patients who were free of cardiovascular symptoms. We found internal carotid artery disease in 63 patients (43%), 26 (18%) with unilateral disease and the other 37 (25%) with bilateral disease. Disease severity was correlated with age but not duration of hypertension, cholesterol level, or current smoking habit We also followed disease progression and clinical outcome with respect to cardiovascular events for 3 years in a subgroup of 95 unselected patients. In 20 of the 93 survivors (21.5%) we noted progression of the atherosclerotic lesions that was predicted by neither risk factors nor initial status of the internal carotid artery. New neurologic symptoms developed in four survivors (4%) and symptoms of cardiac ischemia in six (6%). No survivor who developed new cerebrovascular symptoms showed progression of carotid disease. These data provide useful elements for a rational approach to prevention of the atherosclerotic complications of hypertension. (Stroke 1990^21:410-414) E xperimental, epidemiologic, and clinical evidence shows that arterial hypertension promotes and accelerates atherosclerosis. As a risk factor for atherosclerosis, arterial hypertension affects mainly the cerebral circulation and accounts for an enhanced prevalence of cerebrovascular disease.1 -3 Most strokes have an atherothrombotic origin and are frequently associated with involvement of the extracranial carotid arteries at the bifurcation. However, little is known about the prevalence of atherosclerotic lesions at the carotid bifurcation in hypertensive individuals. The only available data have been obtained from selected subgroups of patients studied by angiography 4 or necropsy.Recently, the advent of noninvasive techniques has made it possible to investigate carotid atherosclerosis in vivo, in asymptomatic patients. Among these new techniques, duplex ultrasonography, which combines B-mode real-time imaging and pulsed Doppler spectral analysis, has gained the widest acceptance. This technique permits direct visualization of the entire spectrum of carotid occlusive disease 8 to detect relevant anatomic details such as the composition and surface characteristics of plaques with a high degree of accuracy. In recent years, duplex ultrasonography has been used extensively to investigate subjects at Received March 17, 1989; accepted October 19, 1989. risk for atherosclerosis. 9-12 However, knowledge concerning hypertensive subjects remains limited.In a previous study on relatively few stable hypertensive patients, 13 we observed that lesions of the internal carotid artery (ICA) occurred more frequently in these patients (28.5%) than in normotensive controls (10%) matched for sex, age, and other major risk factors for cerebrovascular disease. We concluded that arterial hypertension could account for such a difference in the prevalence of ICA lesions independently of other risk factors, ...

Apolipoprotein(a) phenotypes predict the risk for carotid atherosclerosis in patients with end-stage renal disease.

“…54 - 55 We were also unable to observe an association of disease with hypertension and smoking. Similar to another study, 54 our patient group had a very high prevalence (>75%) of hypertension, which makes evaluation of its influence on carotid atherosclerosis difficult.…”

Elevated C-Reactive Protein Is Associated with an Increased Intima to Media Thickness of the Common Carotid Artery

“…age, BMI, pack-years of smoking, incidence of diabetes and stroke [10, 13, 21, 22, 23, 24]. Previous investigators found hypertension to be either associated [25, 26, 27]or not associated [28, 29]with carotid atherosclerosis. Additionally, Sander et al [19]and Sander and Klingelhöfer [25]described the daytime blood pressure variability rather than the absolute blood pressure values as the strongest predictor of early carotid atherosclerosis and progression of IMT.…”

Early Detection of Coronary Artery Flow and Myocardial Perfusion Impairment in Hypertensive Patients Evidenced by Myocardial Blush Grade (MBG) and Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC)

“…90 mmHg (1). An important correlation has been shown between arterial hypertension and the clinical manifestations of ischemic heart disease (2,3), and between the levels of pressure and number and entity of the atherosclerotic lesions (4). Because the earliest manifestation of cardiovascular disease are encountered in the microcirculation, the present study was aimed to appraise the mechanisms that produced myocardial ischemia in Division and Post-Graduate School of Cardiology, Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for the Secondary Prevention, University Hospital "P. Giaccone" of the University of Palermo, Italy hypertensive patients with typical chest pain and absence of coronary stenosis; particularly we tried to appraise the role of the coronary microcirculation valued by Myocardial Blush Grade (MBG) (5) and comparing the results so gotten with the assessment of the coronary flow obtained using the Thrombolysis in Myocardial Infarction (TIMI) Frame Count (TFC) (6, 7).…”