Alterations of carotid arterial mechanics preceding the wall thickening in patients with hypertension
Introduction
Among the various parameters of vascular properties, carotid intima-media thickness (cIMT) has been suggested as a surrogate measure of vascular alterations, and several studies have shown that increasing cIMT is associated with subsequent coronary heart disease and stroke [1], [2]. Since it is non-invasive, reproducible, and simple, measurement of cIMT with ultrasonography is widely used to quantify the extent of subclinical disease in individuals with cardiovascular (CV) risk factors and to follow up in interventional studies. However, cIMT may not reflect the whole arterial changes occurring in various pathologic conditions, such as hypertension. Before the progression of the intima and media thickening, the carotid artery (CA) may experience functional alterations (such as wall stiffening), of which the occurrence is also associated with an increased risk of CV morbidity or mortality by augmenting arterial impedance and resultant increase in the afterload of the heart [3]. Recently, with advancements in ultrasound (US) techniques, a novel automated speckle-tracking method using velocity-vector imaging (VVI) software has facilitated the instantaneous quantification of CA mechanics and we have shown the altered vascular properties associated with aging [4] and arteriopathies [5], [6] such as Takayasu's arteritis and Marfan syndrome. In this study, we aimed to assess whether vascular properties of CA before the progression of cIMT in patients with hypertension are abnormal and different from those of patients with diabetes and controls using VVI analysis.
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Study population
A total of 1024 subjects were recruited from among patients with hypertension or diabetes and healthy subjects. They underwent carotid US for CV risk stratification and general health screening. Among them, 402 asymptomatic subjects were consecutively identified if they had: 1) normal cIMT free from atheromatous plaque on carotid US; 2) hypertension, were normoglycemic, and had no evidence of secondary hypertension; 3) type 2 diabetes mellitus, were normotensive, and were without evidence of
Baseline characteristics
The mean duration of hypertension was 4.1 ± 3.6 years and that of diabetes was 5.3 ± 4.7 years. Among diabetic patients, 16 (11%) were treated with dietary control alone, 113 (75%) with oral hypoglycemic agents (OHA), and 21 (14%) with insulin plus OHA. The mean value of HbA1c was 7.5 ± 1.6%. Table 1 shows the baseline characteristics of the study population according to the subject groups.
Structural and functional characteristics of the carotid artery
Table 2 shows the structural and functional characteristics of the CA. There was no significant difference
Discussion
The principal findings of the current study are: before the development of thickened cIMT, (1) the CA of hypertensive patients was stiffer than that of controls and positive remodeling preceded the wall thickening independent of baseline covariates. (2) the vascular properties of patients with diabetes on conventional treatment were not different from that of controls after adjustments.
To the best of our knowledge, this study is the first to determine the functional and structural alterations
Conclusion
We demonstrated that vascular alterations as arterial stiffening and positive remodeling independently precede the development of wall thickening in patients with hypertension.
On the other hand, vascular properties of patients with diabetes on conventional treatment were not different from that of control before the progression of cIMT. Our results are unique in that they provide earlier detection of arterial changes associated with hypertension, which could be useful for the stratification of
Sources of funding
This work was supported by a Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean government (M10642120001-06N4212-00110).
Disclosures
None.
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