Association Between Pulse Pressure and Carotid Intima-Media Thickness Among Low-Income Adults Aged 45 Years and Older: A Population-Based Cross-Sectional Study in Rural China.

Jie Liu,Xin Zhang,Yijun Song,Dandan Guo,Yuan Yang,Qiuxing Lin,Jinghua Wang,Xianjia Ning,Jun Tu

doi:10.3389/fcvm.2020.547365

Abstract

Worldwide, the stroke burden remains severe, especially for people in low socioeconomic groups. Atherosclerosis is a leading cause of stroke that is attracting increasingly greater attention. Blood pressure, including pulse pressure (PP) and systolic (SBP) and diastolic (DBP) blood pressures, is a traditional risk factor for atherosclerosis; its association with carotid intima-media thickness (CIMT) has also been widely studied. However, published studies have not reported on the relationship between PP and CIMT in low-income adults. Thus, this study investigated the relationship between PP and CIMT in a low-income population, in China. A total of 3,789 people, aged ≥45 years and without histories of stroke or cardiovascular disease, were recruited into this study. B-mode ultrasonography was performed to determine CIMTs. Demographic characteristics, physical examination data, previous medical histories, and laboratory test results were collected for each study participant. Multiple linear regression models were used to analyze the association between CIMT and PP. The mean CIMT was 567.1 μm (males, 583.5 μm; females, 555.7 μm). The SBP, DBP, PP, and mean arterial pressure (MAP) values were all positively correlated with CIMT, in the univariate analysis; PP and MAP showed the strongest correlations. In addition, in three multiple linear regression models, PP was shown to be significantly associated with CIMT; each 1-mm Hg increase in PP resulted in a CIMT increase of ≥0.41 μm (all P < 0.001). Our results demonstrated that, when compared with SBP, DBP, and MAP, PP may be the best predictor of CIMT. Thus, controlling blood pressure, especially PP levels, is vital to decreasing the prevalence of atherosclerosis, especially in this low socioeconomic status population in China.

Highlights

Stroke is the main cause of death and disability, worldwide [1], and is the leading cause of death in China [2]
Model 1 analysis adjusted by age, sex, and education; Model 2 analysis adjusted by age, sex, education, hypertension, diabetes, smoking, and drinking; Model 3 analysis adjusted by age, sex, education, hypertension, diabetes, smoking, drinking, fasting blood glucose; triglycerides; high-density lipoprotein cholesterol (HDL-C); low-density lipoprotein cholesterol (LDL-C); HDL-C/LDL-C. 95% confidence intervals (CIs), 95% confidence interval; PP, pulse pressure; MAP, mean arterial pressure. *represents P < 0.05
This study focused on the relationship between PP and carotid intima-media thickness (CIMT) in low socioeconomic status adults in China

Summary

Introduction

Stroke is the main cause of death and disability, worldwide [1], and is the leading cause of death in China [2]. As the leading cause of stroke, atherosclerosis causes 10–20% of cerebral infarction events [4] and 20–30% of ischemic stroke events [5]Carotid intima-media thickness (CIMT) is a useful measure for detecting early atherosclerotic changes [6], and previous studies have demonstrated that an increased CIMT is a marker of atherosclerosis [7, 8]. In women with coronary artery disease, followed for 3.2 years, high baseline pulse pressures (PPs) were associated with coronary atherosclerosis progression [10]. A previous study of adults with hypertension demonstrated that diastolic blood pressure (DBP) was lower in the group with increased CIMTs than it was in the group with normal CIMTs; PPs and the PP index [(SBP-DBP)/DBP] were significantly higher in the group with increased CIMTs [13]

Methods

Results

Discussion

Conclusion