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Association of Blood Pressure Levels with Carotid Intima-Media Thickness and Plaques

혈압 수준과 경동맥 내중막 두께 및 동맥경화반의 관련성

  • Lee, Young-Hoon (Department of Preventive Medicine, College of Medicine, Seonam University) ;
  • Kweon, Sun-Seog (Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital) ;
  • Choi, Jin-Su (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Rhee, Jung-Ae (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Choi, Sung-Woo (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Ryu, So-Yeon (Department of Preventive Medicine, Chosun University College of Medicine) ;
  • Shin, Min-Ho (Department of Preventive Medicine, Chonnam National University Medical School)
  • 이영훈 (서남대학교 의과대학 예방의학교실) ;
  • 권순석 (화순전남대학교병원 전남지역암센터) ;
  • 최진수 (전남대학교 의과대학 예방의학교실) ;
  • 이정애 (전남대학교 의과대학 예방의학교실) ;
  • 최성우 (전남대학교 의과대학 예방의학교실) ;
  • 류소연 (조선대학교 의과대학 예방의학교실) ;
  • 신민호 (전남대학교 의과대학 예방의학교실)
  • Published : 2009.09.30

Abstract

Objectives : The aim of this study was to investigate the association of blood pressure levels with the common carotid artery intima-media thickness (CCA-IMT) and carotid plaques. Methods : Data were obtained from 2,635 subjects, aged 50 years and over, who participated in the Community Health Survey (a population-based, cross-sectional study) in Dong-gu, Gwangju city between 2007 and 2008. Participants were categorized into three groups according to blood pressure levels; normotensives (<120/80 mmHg), prehypertensives (120-139/80-89 mmHg), and hypertensives ($\geq$140/90 mmHg). Prehypertensives were further categorized as low prehypertensives (120-129/80-84 mmHg) and high prehypertensives (130-139/85-89 mmHg). Carotid intima-media thickness and plaques were evaluated with a high-resolution B-mode ultrasound. Statistical analyses were performed using chi-square test, ANOVA, and multiple logistic regression. Results : Prehypertensives had significantly greater maximal CCA-IMT values than normotensives, with a multivariate adjusted odds ratio of 1.78 (95% CI=1.36-2.32) for abnormal CCA-IMT (maximal CCA-IMT$\geq$1.0 mm), and 1.45 (95% CI=1.19-1.77) for carotid plaques. The multivariate adjusted odds ratio of low prehypertensives was 1.64 (95% CI=1.21-2.21) for abnormal CCA-IMT, and 1.30 (95% CI=1.04-1.63) for carotid plaques compared with normotensives. Subject with hypertension had higher frequency of abnormal CCA-IMT (odds ratio, 2.18; 95% CI=1.49-3.18), and carotid plaques (odds ratio, 1.98; 95% CI=1.46-2.67) compared with normotensives after adjustment for other cardiovascular risk factors. Conclusions : Our results indicate that there is a significant increase in the prevalence of carotid atherosclerosis in subjects with prehypertension (even in low prehypertensives) compared with normotensive subjects. Further studies are required to confirm the benefits and role of carotid ultrasonography in persons with prehypertension.

Keywords

References

  1. Korea National Statistical Office. Annual report on the cause of death statistics 2007. Daejeon: Korea National Statistical Office; [cited 2009 April 1]. Available from: URL:http://www.nso.go.kr. (Korean)
  2. Izzo JL Jr, Black HR, editors. Hypertension Primer: The Essentials of High Blood Pressure. 2nd ed. Baltimore: Lippincott Williams & Wilkins; 1999
  3. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351(9118): 1755-1762 https://doi.org/10.1016/S0140-6736(98)04311-6
  4. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003; 289(19): 2560-2572 https://doi.org/10.1001/jama.289.19.2560
  5. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360(9349):1903-1913 https://doi.org/10.1016/S0140-6736(02)11911-8
  6. Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: A new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002; 20(2): 159-169 https://doi.org/10.1097/00004872-200202000-00001
  7. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: The Muscatine Study. Circulation 2001; 104(23): 2815-2819 https://doi.org/10.1161/hc4601.099486
  8. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: The Atherosclerosis Risk in Communities(ARIC) Study, 1987-1993. Am J Epidemiol 1997; 146(6): 483-494 https://doi.org/10.1093/oxfordjournals.aje.a009302
  9. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation 2007; 115(4): 459-467 https://doi.org/10.1161/CIRCULATIONAHA.106.628875
  10. Puato M, Palatini P, Zanardo M, Dorigatti F, Tirrito C, Rattazzi M, et al. Increase in carotid intima-media thickness in grade I hypertensive subjects: White-coat versus sustained hypertension. Hypertension 2008; 51(5): 1300-1305 https://doi.org/10.1161/HYPERTENSIONAHA.107.106773
  11. Toikka JO, Laine H, Ahotupa M, Haapanen A, Viikari JS, Hartiala JJ, et al. Increased arterial intima-media thickness and in vivo LDL oxidation in young men with borderline hypertension. Hypertension 2000; 36(6): 929-933 https://doi.org/10.1161/01.HYP.36.6.929
  12. Pauletto P, Palatini P, Da Ros S, Pagliara V, Santipolo N, Baccillieri S, et al. Factors underlying the increase in carotid intima-media thickness in borderline hypertensives. Arterioscler Thromb Vasc Biol 1999; 19(5):1231-1237 https://doi.org/10.1161/01.ATV.19.5.1231
  13. Prati P, Tosetto A, Vanuzzo D, Bader G, Casaroli M, Canciani L, et al. Carotid intima media thickness and plaques can predict the occurrence of ischemic cerebrovascular events. Stroke 2008; 39(9): 2470-2476 https://doi.org/10.1161/STROKEAHA.107.511584
  14. Liszka HA, Mainous AG 3rd, King DE, Everett CJ, Egan BM. Prehypertension and cardiovascular morbidity. Ann Fam Med 2005; 3(4): 294-299 https://doi.org/10.1370/afm.312
  15. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness consensus (2004-2006): An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 2007; 23(1): 75-80 https://doi.org/10.1159/000097034
  16. Roman MJ, Naqvi TZ, Gardin JM, Gerhard-Herman M, Jaff M, Mohler E. American society of echocardiography report: Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification. A report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. Vasc Med 2006; 11(3): 201-211 https://doi.org/10.1177/1358863x06070511
  17. Casella IB, Presti C, Porta RM, Sabbag CR, Bosch MA, Yamazaki Y. A practical protocol to measure common carotid artery intimamedia thickness. Clinics (Sao Paulo) 2008;63(4): 515-520 https://doi.org/10.1590/S1807-59322008000400017
  18. Kanters SD, Algra A, van Leeuwen MS, Banga JD. Reproducibility of in vivo carotid intima-media thickness measurements: A review. Stroke 1997; 28(3): 665-671 https://doi.org/10.1161/01.STR.28.3.665
  19. Greenlund KJ, Croft JB, Mensah GA. Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999-2000. Arch Intern Med 2004; 164(19): 2113-2118 https://doi.org/10.1001/archinte.164.19.2113
  20. Yu D, Huang J, Hu D, Chen J, Cao J, Li J, Gu D. Prevalence and risk factors of prehypertension among Chinese adults. J Cardiovasc Pharmacol 2008; 52(4): 363-368 https://doi.org/10.1097/FJC.0b013e31818953ac
  21. Grotto I, Grossman E, Huerta M, Sharabi Y. Prevalence of prehypertension and associated cardiovascular risk profiles among young Israeli adults. Hypertension 2006; 48(2): 254-259 https://doi.org/10.1161/01.HYP.0000227507.69230.fc
  22. Tsai PS, Ke TL, Huang CJ, Tsai JC, Chen PL, Wang SY, et al. Prevalence and determinants of prehypertension status in the Taiwanese general population. J Hypertens 2005; 23(7): 1355-1360 https://doi.org/10.1097/01.hjh.0000173517.68234.c3
  23. Korea Centers for Disease Control and Prevention. In-depth Analysis of the Third National Health and Nutrition Examination Survey: Health Examination. Seoul: Korea Centers for Disease Control and Prevention; 2007. p.37-66
  24. O'Donnell CJ, Ridker PM, Glynn RJ, Berger K, Ajani U, Manson JE, et al. Hypertension and borderline isolated systolic hypertension increase risks of cardiovascular disease and mortality in male physicians. Circulation 1997; 95(5): 1132-1137 https://doi.org/10.1161/01.CIR.95.5.1132
  25. Qureshi AI, Suri MF, Kirmani JF, Divani AA, Mohammad Y. Is prehypertension a risk factor for cardiovascular diseases? Stroke 2005; 36(9): 1859-1863 https://doi.org/10.1161/01.STR.0000177495.45580.f1
  26. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: A cohort study. Lancet 2001; 358(9294): 1682-1686 https://doi.org/10.1016/S0140-6736(01)06710-1
  27. Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB, et al. Impact of highnormal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345(18): 1291-1297 https://doi.org/10.1056/NEJMoa003417
  28. Lemne C, Jogestrand T, de Faire U. Carotid intima-media thickness and plaque in borderline hypertension. Stroke 1995; 26(1): 34-39 https://doi.org/10.1161/01.STR.26.1.34
  29. Perktold K, Resch M, Peter RO. Threedimensional numerical analysis of pulsatile flow and wall shear stress in the carotid artery bifurcation. J Biomech 1991; 24(6): 409-420 https://doi.org/10.1016/0021-9290(91)90029-M
  30. Dobrin PB. Mechanical factors associated with the development of intimal and medial thickening in vein grafts subjected to arterial pressure: A model of arteries exposed to hypertension. Hypertension 1995; 26(1): 38-43 https://doi.org/10.1161/01.HYP.26.1.38
  31. Toprak A, Wang H, Chen W, Paul T, Ruan L, Srinivasan S, et al. Prehypertension and blackwhite contrasts in cardiovascular risk in young adults: Bogalusa Heart Study. J Hypertens 2009; 27(2): 243-250 https://doi.org/10.1097/HJH.0b013e32831aeee3
  32. Femia R, Kozakova M, Nannipieri M, Gonzales-Villalpando C, Stern MP, Haffner SM, et al. Carotid intima-media thickness in confirmed prehypertensive subjects: predictors and progression. Arterioscler Thromb Vasc Biol 2007; 27(10): 2244-2249 https://doi.org/10.1161/ATVBAHA.107.149641
  33. Manios E, Tsivgoulis G, Koroboki E, Stamatelopoulos K, Papamichael C, Toumanidis S, et al. Impact of prehypertension on common carotid artery intima-media thickness and left ventricular mass. Stroke 2009; 40(4): 1515-1518 https://doi.org/10.1161/STROKEAHA.108.528174
  34. Kim SJ, Jung KS, Lee KH, Choi SH, Lee KE, Lee SH, et al. The change in carotid intima-media thickness in prehypertensive adults. Korean J Med 2006; 70(2): 165-171. (Korean)
  35. Rundek T, Arif H, Boden-Albala B, Elkind MS, Paik MC, Sacco RL. Carotid plaque, a subclinical precursor of vascular events: The Northern Manhattan Study. Neurology 2008; 70(14): 1200-1207 https://doi.org/10.1212/01.wnl.0000303969.63165.34
  36. Prati P, Vanuzzo D, Casaroli M, Bader G, Mos L, Pilotto L, et al. Determinants of carotid plaque occurrence: A long-term prospective population study. The San Daniele Project. Cerebrovasc Dis 2006; 22(5-6): 416-422 https://doi.org/10.1159/000094993
  37. de Freitas EV, Brandao AA, Pozzan R, Magalhies ME, Castier M, Brandao AP. Study of the intima-media thickening in carotid arteries of healthy elderly with high blood pressure and elderly with high blood pressure and dyslipidemia. Clin Interv Aging 2008; 3(3): 525-534 https://doi.org/10.2147/CIA.S213
  38. Bots ML, Hofman A, Grobbee DE. Increased common carotid intima-media thickness: Adaptive response or a reflection of atherosclerosis? Findings from the Rotterdam Study. Stroke 1997; 28(12): 2442-2447 https://doi.org/10.1161/01.STR.28.12.2442

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