Abstract
Background: Although high blood pressure (BP) is a risk factor for carotid plaque, its long-term prognostic value might be underestimated due to its confounding interactions with BMI, age, and gender. Therefore, we conducted a 7-year prospective cohort study to evaluate the prognostic value of BP for the incidence of carotid plaque.Methods: The subjects enrolled in 2011 were free of carotid plaque at baseline and were followed up in 2018. Multivariate Cox proportional-hazards models were used to evaluate the association between BP and carotid plaque incidence.Results: During the follow-up study, the incidence of carotid plaque was 36.5%. The significant positive linear trend showed that subjects with higher BP levels at baseline were more likely to develop carotid plaques at the end. Especially in the female subpopulation, after confounders being adjusted, the carotid plaque was associated with higher BP (adjusted HR 1.52, 95% CI 1.02–2.26), pulse pressure (PP) (adjusted HR 1.15, 95% CI 0.76–1.75), and mean arterial pressure (MAP) (adjusted HR 1.44, 95% CI 1.00–2.08). The adjusted HRs of hypertension, PP, and MAP (HR 27.71, 95% CI 2.27–338.64; HR 14.47, 95% CI 1.53–137.18; HR 9.97, 95% CI 1.29–77.28) were significantly higher after the potential antagonistic interactions between BP categorical indicators and age being adjusted, respectively.Conclusion: High BP indicators might be associated with higher HRs of carotid plaque after adjusting interactions between BP indicators and BMI, age, and gender, which suggests that the incidence of carotid plaque in female adults with high BP indicators might increase significantly with the increase of age.
Highlights
One-third of the adult population in China has been diagnosed with carotid atherosclerosis, leading to a heavy economic and social burden (Clarke et al, 2017)
The interactions between blood pressure (BP) indicators and other cardiovascular risk factors for the carotid plaque have not been systematically analyzed (Yang et al, 2013; Clarke et al, 2017). This interaction may be involved in the formation of carotid plaque (Rovella et al, 2018) and the observational studies of these potential interactions were still unclear. In this 7-year follow-up cohort study, we aimed to explore the possible interactions between BP categorical indicators and age, Body mass index (BMI), and gender in the associations of BP and incidence of carotid plaque
The findings showed that higher BP indicators might be associated with higher hazard ratios (HRs) of carotid plaque after adjusting for interactions between BP indicators and parameters such as BMI, age, and gender
Summary
One-third of the adult population in China has been diagnosed with carotid atherosclerosis, leading to a heavy economic and social burden (Clarke et al, 2017). The risk factors for carotid plaque include age, sex, hypertension, diabetes, and dyslipidemia (Noflatscher et al, 2018; Zhao and Hatsukami, 2018). Hypertension is the leading modifiable risk factor for cardiovascular diseases including carotid plaque (Hellings et al, 2010; Franceschini et al, 2018; Sillesen et al, 2018). The interactions between BP indicators and other cardiovascular risk factors for the carotid plaque have not been systematically analyzed (Yang et al, 2013; Clarke et al, 2017). We conducted a 7-year prospective cohort study to evaluate the prognostic value of BP for the incidence of carotid plaque
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