DIFFERENCES IN LONG-TERM CHANGES IN CAROTID REMODELING BETWEEN NORMOTENSIVE AND HYPERTENSIVE PERSONS IN A PRIMARY CARE POPULATION

Abstract

Objective: We aimed to prospectively investigate whether there are differences between carotid remodeling between hypertensive and normotensive people over time. Design and method: In a prospective longitudinal cohort study we compared common carotid artery ultrasonography measurements from hypertensive patients with normotensive volunteers from a single general practice. We assessed markers of arterial remodeling intima-media thickness (IMT), lumen diameter (LD), cross-sectional area (CSA), circumferential wall tension (CWT), and circumferential wall stress (CWS), at baseline and after follow-up. We analyzed change in these markers over time as well as differences between both groups, correcting for confounders using GEE-analysis. Results: From a baseline cohort of 174 normotensives and 317 hypertensive participants, a total of 128 normotensives and 94 hypertensives completed follow-up after 6.1 ± 1.1 years. Hypertensives had higher levels of carotid remodeling than normotensives: IMT 733 ± 134 vs. 649 ± 130 um (p < 0.001), LD 6.5 ± 0.9 vs. 6.0 ± 0.8 mm (p < 0.001), CSA 16.7 ± 4.3 vs. 13.7 ± 3.7 mm2 (p < 0.001), CWT 47.2 ± 8.4 vs. 39.8 ± 7.3 kPa (p < 0.001), and CWS 67.1 ± 15.3 vs. 63.8 ± 14.8 kPa (p < 0.01), respectively. Longitudinally, IMT, LD, and CSA did not change in hypertensives, but rose significantly in normotensives (Figure). CWT and CWS fell in hypertensives, whereas in normotensives CWT rose but CWS did not change significantly (Figure). Normotensives had higher rates of change in IMT (β 9.9 p < 0.001), LD (β 0.03 p = 0.044) and CSA (β 0.3 p < 0.001) but there was no difference in CWS between hypertensives and normotensives. Independent determinants of carotid remodeling were male sex, age, smoking, and pulse pressure. Use of angiotensin receptor blockers was associated with decrease in CWS (β −4.9 p < 0.05). Conclusions: Established hypertensives have maladaptive carotid remodeling compared to normotensives but arterial dimensions do not change significantly over time. However, in normotensives carotid characteristics change significantly over time. We conclude that although hypertension is associated with maladaptive remodeling the process seems to commence even before overt hypertension is established.