Abstract
Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0
Highlights
The early detection of vascular injury in subclinical hypertensive disease may be the key point to delay or even prevent major cardiovascular outcomes.[1]The measurement of the carotid artery intima-media thickness (CA-IMT) using ultrasound is a low cost, available, reproducible method, with no risks associated, and with good histopathological correlation.[2]
Central hemodynamic measures obtained by the SphygmoCor® and the Mobil-O-Graph® were not different, except for central pulse pressure (cPP) and pulse wave velocity (PWV), which were lower
No correlation was found between CA-IMT and peripheral blood pressure (pBP) or central blood pressure (cBP)
Summary
The early detection of vascular injury in subclinical hypertensive disease may be the key point to delay or even prevent major cardiovascular outcomes.[1]. The measurement of the carotid artery intima-media thickness (CA-IMT) using ultrasound is a low cost, available, reproducible method, with no risks associated, and with good histopathological correlation.[2] It is useful as a non-invasive assessment method of vascular hypertrophy and atherosclerotic disease;[3] it is considered a robust predictor of cardiovascular events and surrogate marker of atherosclerosis. Its clinical use is a component of the risk score for coronary events.[4]. Manuscript received June 14, 2019; revised manuscript April 11, 2020; accepted May 16, 2020. The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes
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