Carotid Arteries In Hypertensive Patients Research Articles

The Difference of Mean WSS Value on The Carotid Bifurcation and The Medial Segment of Common Carotid Artery Using Vector Flow Ultrasonography in Hypertensive Patients at Prof Dr. I.G.N.G Ngoerah General Hospital February-April 2022

Background : Hypertension is a risk factor for atherosclerosis which increases the risk of stroke. Transitions in blood vessels such as bifurcations are associated with changes in the velocity and pattern of blood flow that decrease wall shear stress (WSS) and is believed to be a risk factor for atherosclerosis. Shear stress on the common carotid artery also decreased with increasing blood pressure. This study aims to determine the difference of mean WSS value on the carotid bifurcation and the medial segment of common carotid artery using vector flow ultrasonography in hypertensive patients. Methods: This study used a cross-sectional design with the research location at the Radiology Installation of Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar in February-April 2022. The sample of this study was hypertensive patients who came to the Radiology Installation of Prof. Dr. I.G.N.G Ngoerah Hospital and met the inclusion criteria as many as 32 people. The examination was carried out by a consultant of head and neck radiology, using an ultrasound device with a linear transducer probe that has a probe frequency range of 3-9 Mhz. Results: The average age of the sample in this study was 50 years, with 9 males (28.1%), 23 females (71.9%). The results showed that the average maximum WSS value on the carotid bifurcation (3.37±0.96) Pa, the mean value (1.15±0.45) Pa, while the average maximum WSS value on the medial segment of the common carotid artery (4 ,41±1.45)Pa, the mean value (1.78±0.54)Pa. The average maximal and mean WSS value on carotid bifurcation were lower than the medial segment of the common carotid artery in hypertensive patients (p<0,05). The results of multivariate analysis on WSS values after controlling for confounding variables, obtained the average maximal and mean WSS value on carotid bifurcation, remained lower than the medial segment of the common carotid artery (p<0,05). Conclusion: there were significant differences in the mean wall shear stress (WSS) of the carotid bifurcation and the medial segment of the common carotid artery in hypertensive patients. Suggestions that can be done next are in facilities that have vector flow ultrasonography facilities, it is recommended to measure the WSS value in hypertensive patients as additional information as a predictor of atherosclerosis

ВЗАИМОСВЯЗЬ МЕЖДУ СУБКЛИНИЧЕСКИМИ СТРУКТУРНЫМИ ИЗМЕНЕНИЯМИ СОННОЙ АРТЕРИИ И КОГНИТИВНЫМИ ФУНКЦИЯМИ У ПАЦИЕНТОВ С ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ

Introduction. At present, a number of clinical studies have confirmed the relationship between blood pressure and cognitive impairment. Objective. The aim of the study was to analyze the relationship between cognitive impairment and subclinical changes in carotid arteries in hypertensive patients. Material and methods. 69 patients with hypertensive disease of the II stage, average age of 51.38 ± 0.94 years, were examined. Patients were divided into 2 groups with absence and presence of cognitive impairment. The examination of the right common carotid artery was carried out using an ultrasound multifunction scanner. To study cognitive impairment used a number of MoCA test. Results. The average thickness of the intima-media complex in the patients of the first and second groups was not significantly different. The proportion of people with intima-media complex thickness exceeding normal values was significantly higher in persons with cognitive impairment (71%) than in persons without them (39.5%). Сonclusions. In patients with stage II of hypertensive disease, the thickness of the intima-media complex of the carotid artery was increased. A positive correlation of increased thickness of the intoma-media complex with hypertensive crises was found only in persons with cognitive impairment.

Characteristics of changes and clinical and instrumental predictors of the severity of structural remodelling of carotid arteries in hypertensive patients

Background. Mechanisms of activation of the process of vascular wall remodelling in patients affected by arterial hypertension have not been studied in depth and require clarification. Materials and methods. The study included 381 patients with hypertension — 212 men and 169 women of the average age 53.0 (47; 60) years. The structural-functional vessel status was determined by the method of duplex scanning and colour duplex mapping of blood flow with the Logiq 500 MO apparatus (GE, USA). Statistical analyses were made using Microsoft Excel software kit, Statistica for Windows 6.0. Results. The patients with hypertension presented some left-right asymmetry of remodelling extracranial carotid arteries. Unlike the impact of remodelling of the right carotid artery, the most essential effect on the left carotid artery was the impact of daytime pulse arterial pressure and variability of the nocturnal systolic arterial pressure (the strength of impact 25.0 and 13.9%, respectively. The processes of remodelling of the right carotid artery are more sensible to the impact of high values of nocturnal diastolic arterial pressure (the strength of impact 16.4%). The beginning of some brain complication is associated with the significant increase in atherosclerotic affection not only of the left, but also of the right carotid artery. Conclusions. Remarkable remodelling of the right carotid artery is often associated with the severity of the disease and to some extent reflects the severity of the flow of the disease and can be regarded as an additional unfavourable feature.

Interrelation between ambulatory blood pressure indices and the lesions of the common carotid arteries in hypertensive patients at early post-stroke period

Objective. To study the variability of blood pressure (BP) based on ambulatory BP monitoring and its correlation with the state of the walls of the carotid arteries in hypertensive post-stroke patients. Design and methods. Anthropometry, fasting blood glucose tests and lipid profile, BP monitoring, doppler ultrasound of the carotid arteries were performed in 90 subjects. Results. There is a positive correlation between indicators of ambulatory BP monitoring and the state of the walls of the carotid arteries, in particular, between daytime variability of systolic BP (SBP) and the diameter of the common carotid arteries (R = 0,5; p < 0,05). A negative correlation between nocturnal SBP variability and blood flow velocity in the common carotid arteries (R = –0,5; p < 0,05) and a positive relation between daytime time index of SBP and resistivity index in external carotid arteries (R = 0,61; p < 0,05) were determined. Mean ambulatory SBP level is directly correlated with the resistivity index of the internal carotid arteries and blood flow velocity in the common carotid arteries (R = 0,52; p < 0,05). There is a correlation between the degree of nocturnal SBP reduction and intima-media thickness (R = –0,62; p < 0,001). Correlation was determined between the degree of nocturnal diastolic BP reduction and blood flow velocity in the common carotid arteries (R = 0,65; p < 0,05). Conclusions. There is a violation of circadian BP profile in all hypertensive patients after stroke, despite achieved target levels of BP. There is a correlation between the severity of atherosclerotic lesions of common carotid arteries and lipid metabolism, age, as well as with ambulatory BP indices. Thus, 24-hour BP parameters should be considered when evaluating the effectiveness of antihypertensive therapy in hypertensive post-stroke patients.

Пружно-еластичні властивості загальних сонних артерій у хворих на артеріальну гіпертензію

Мета дослідження: виявити закономірності змін пружно-еластичних властивостей судин на прикладі загальних сонних артерій у хворих на артеріальну гіпертензію залежно від наявності ознак недиференційованої дисплазії сполучної тканини.Методи дослідження. Обстежені 54 пацієнти віком від 30 до 59 років з артеріальною гіпертензією з підвищеним артеріальним тиском 2–3-го ступеня, високим і дуже високим додатковим ризиком. Залежно від наявності ознак недиференційованої дисплазії сполучної тканини хворі розподілені на 2 групи. За допомогою сонографії високої роздільної здатності досліджували діаметр загальних сонних артерій у систолу та діастолу, товщину комплексу інтима-медіа, розраховували модулі Юнга та Петерсона, коефіцієнти радіального напруження стінки судини, лінійної розтяжності, індекс жорсткості, локальну швидкість поширення пульсової хвилі по загальних сонних артеріях.Результати. Показники пружно-еластичних властивостей загальних сонних артерій у хворих на артеріальну гіпертензію з ознаками недиференційованої дисплазії сполучної тканини демонструють меншу жорсткість порівняно з такими у хворих без цих ознак. Вираженість ознак недиференційованої дисплазії сполучної тканини визначає величину модуля Петерсона, і ця залежність має поліноміальний зворотно-пропорційний характер. Виявлено відмінності в показниках, що досліджувалися, правої та лівої загальних сонних артерій, яка досягає достовірної величини відносно коефіцієнту лінійної розтяжності у всіх обстежених пацієнтів.

383 Carotid arterial flow control in hypertensive patients- analysis by wave intensity

Background: Wave reflection from the head and neck augments pressure and decelerates flow in the carotid artery. Wave intensity (WI) has the potential to separate peripheral (head and neck) effects from ventricular effects on pressure and flow waves. WI is defined as the product of the time derivatives of blood pressure (P) and velocity (U): WI=(dP/dt)(dU/dt). The negative value of WI indicates that the effects of reflected waves are predominant. Therefore, the integral of negative values (NA) of common carotid arterial WI in a cardiac cycle is attributed to reflection from the head and neck. To elucidate the characteristics of carotid arterial flow control in hypertensive subjects, we applied WI analysis. Methods: We measured WI in 64 hypertensive patients (HT) (mean age 63±4 years, mean systolic/diastolic pressure 149±11/82±10 mm Hg) and 63 agematched normal subjects (N) (mean age 63±7 years, mean systolic/diastolic pressure 121±17/70±10 mm Hg) with a noninvasive WI measuring system (SSD 6500, Aloka Co), which simultaneously measured common carotid arterial blood flow velocity and diameter change. The diameter change waveform calibrated by blood pressure by upper arm automated sphygmomanometry was used as the pressure waveform. The volume flow rate (Q) was calculated as the integral of the product of cross-sectional mean velocity and cross-sectional area of the artery over a cardiac cycle, multiplied by heart rate. Results: The maximum diameter was larger (8.30±0.7 vs 7.8±0.7 mm, p<0.0001) and the maximum blood flow velocity was lower (50±14 vs 55± ± 11 cm/s, p<0.05) in HT than N. NA was greater (38±19 vs 26±15 mm Hg m/s2, p<0.0001) in HT, which suggests higher reflection from the head and neck. There was no difference in the highest values of WI and Q between HT and N (WI: 10.6±6.4 vs 8.6±3.6 mm Hg m/s3, Q: 658±158 vs 680±178 ml/min). Conclusions: The common carotid artery in HT had larger diameter and lower blood velocity, i.e. reduced shear stress. Q was maintained at the same values as N with enhanced reflection from the cerebral circulation.

A single nucleotide polymorphism in the promoter region of the osteoprotegerin gene is related to intima‐media thickness of the carotid artery in hypertensive patients. The Swedish irbesartan left ventricular hypertrophy investigation vs atenolol (SILVHIA)

Osteoprotegerin (OPG) is a secreted member of the tumor necrosis factor receptor family, and in previous studies has been shown to regulate osteoclast activity and differentiation. Ablation of the OPG gene in mice results in calcification of the aorta and renal arteries. We have previously reported an association between a single nucleotide polymorphism in the promoter region of OPG and vascular morphology and function in healthy humans. The objective with this study was to confirm our previous results in a larger population, and in addition, to study subjects with hypertension. The OPG genotype was determined by restriction fragment length and the intima‐media thickness (IMT) of the common carotid artery was measured by ultrasound in 100 patients with hypertension and left ventricular hypertrophy, and 75 healthy normotensive control subjects. In the hypertensive group subjects with the CC genotype (n = 24) showed a significantly increased IMT compared to those with the TC (n = 52, p = 0.007) and TT (n = 24, p = 0.009) genotype, in the hypertensive group only (mean ± SD for TT = 0.88 ± 0.21 mm, TC = 0.90 ± 0.16 mm, CC = 1.05 ± 0.31 mm). The allele distribution did not differ between hypertensive and control individuals. The present study confirms our previous finding and shows that polymorphism in the promoter region of OPG is associated with vascular morphology in hypertensive subjects.

Effects of blood pressure lowering with amlodipine or lisinopril on vascular structure of the common carotid artery

Increased intima-media thickness of the common carotid artery predicts increased risk of myocardial infarction and stroke. Preliminary evidence suggests that a decrease in blood pressure (BP) is associated with diminished wall thickness. It is not known if all classes of anti-hypertensive agents have similar protective effects. In this double-blind parallel-group clinical trial, 69 previously untreated patients with hypertension were allocated randomly to 1 year of treatment with either amlodipine (5-10 mg daily) or lisinopril (5-20 mg daily). Doxazosin and bendrofluazide were added if required to achieve BP control. After 12 months of treatment, clinic BP, ambulatory BP and cardiac mass were reduced similarly by the two treatment regimens. Common carotid artery intima-media thickness decreased by 0.048 mm (95% confidence intervals -0.066, -0.031 mm) in the amlodipine-treated group, but decreased by only 0.027 mm (-0.046, -0.007 mm) in the lisinopril-treated group (P<0.05 for difference between treatments). Common carotid artery lumen diameter declined significantly only in patients treated with lisinopril [amlodipine, -0.02 mm (-0.14, 0.10 mm); lisinopril, -0.21 mm (-0.32, -0.11 mm); P<0.02], while intima-media area declined similarly in the two treatment groups [amlodipine -1.32 mm(2) (-1.91, -0.74 mm(2)), lisinopril -1.26 mm(2) (-1.80, -0.72 mm(2)); not significant]. The results confirm that a decrease in BP causes regression of structural changes in the carotid artery in hypertensive patients. The nature of the structural regression differed markedly between the two treatment regimens, in spite of similar decreases in BP. The calcium channel blocker induced greater regression of common carotid artery intima-media thickness than the angiotensin-converting enzyme inhibitor. However, carotid artery wall mass, as indicated by intima-media area, was reduced to a similar extent by the two treatments. It remains to be established whether such differences confer a prognostic advantage.

Ultrasonographic study of atherosclerotic and non-atherosclerotic lesions of the carotid arteries in hypertensive patients.

Ultrasonographic study of atherosclerotic and non-atherosclerotic lesions of the carotid arteries in hypertensive patients.

Low wall shear stress contributes to atherosclerosis of the carotid artery in hypertensive patients.

Numerous in vitro studies have indicated that low shear stress may contribute to intimal thickening and development of atherosclerosis. In the present study, we investigated wall shear stress in hypertensive patients and its relevance to atherosclerosis in the carotid arteries by means of a non-invasive technique. Fifty-five hypertensive patients and 23 normotensive controls were investigated. Intima-media thickness, number of plaques, internal dimension and blood flow velocity of the carotid artery were evaluated. Wall shear stress was calculated using the Poiseuillean parabolic model of velocity distribution as follows: shear stress = 4 X blood viscosity X central line flow velocity/internal dimension. Hypertensive patients showed increased intima-media thickness and dilated common carotid arterial dimension relative to normotensive controls. There was no difference in blood viscosity between the two groups. Both the mean shear stress and systolic peak shear stress were significantly lower in hypertensive patients than normotensive controls. Further, wall shear stress at both mean and peak velocity was significantly and negatively related to intima-media thickness and number of plaques in hypertensive patients, as well as in the total study population. These findings indicate that structural and functional alterations in the common carotid artery of hypertensive patients further precipitates atherosclerosis through low shear stress.

Structural Changes in the Heart and Carotid Arteries in Hypertensive Patients Associated with Cardiovascular Risk Factors

To estimate the relationship between structural changes in the heart and in the carotid arteries in hypertensives and to analyze the correlations between these structural changes and cardiovascular risk factors. We studied 76 subjects (39 men and 27 women, mean age 45+/-7 years) with mild-to-moderate untreated and uncomplicated hypertension. All of the subjects underwent ambulatory blood pressure monitoring, M-mode echocardiography for evaluation of their left ventricular mass and B-mode high-resolution ultrasonography to determine their carotid arterial wall thickness. The mean intimal plus medial thickness of the common carotid artery was found to be related significantly and independently to the left ventricular mass indexed by the body surface area. In multivariate analysis, age and the high-density lipoprotein cholesterol level were related strongly to the intimal plus medial thickness, whereas the clinic systolic blood pressure, average night-time systolic blood pressure and glycemia were the most important determinants of the left ventricular mass index. Logistic regression analysis suggested that the thickness of the posterior left ventricular wall was a stronger predictor of the carotid intima-medial thickness than were age and the high-density lipoprotein cholesterol level. The carotid wall thickness and left ventricular mass of hypertensives are related independently; nevertheless the main determinants of structural cardiac and vascular changes are probably different.

Structural changes in the heart and carotid arteries in hypertensive patients associated with cardiovascular risk factors

Structural changes in the heart and carotid arteries in hypertensive patients associated with cardiovascular risk factors

Similarities and differences in structural and functional changes of left ventricle and carotid arteries in young borderline hypertensives and in athletes.

To investigate the association between increased left ventricular mass and the intima-media thickening of carotid arteries in hypertensive patients and the simultaneous involvement of the heart and the conductance vessels by the hypertensive process. Because no data are available concerning the ultrasonographic characteristics of large arteries in athletes with physiological increases in left ventricular mass, we measured the intima-media thickness (IMT) of the common carotid artery (CCA) in 14 normotensive subjects (group I, aged 22 +/- 4 years), in 14 borderline hypertensives (group II, aged 24 +/- 6 years) and in 14 Japanese wrestling players (group III, aged 23 +/- 4 years). The IMT of the posterior wall of the CCA was measured at 5, 10 and 20mm caudally to the bifurcation and the measurements were averaged. Left ventricular diameters and thicknesses of the interventricular septum and posterior wall were obtained from two-dimensionally guided M-mode tracings and measured according to the Penn convention. Left ventricular mass was calculated by the formula of Devereux. Left ventricular filling was measured by a pulsed Doppler technique. Both systolic and diastolic blood pressure values were significantly higher in group II (145 +/- 7/91 +/- 5 mmHg) than they were in group I (116 +/- 11/75 +/- 5 mmHg) and in group III (120 +/- 8/78 +/- 6 mmHg). In athletes and hypertensives both the left ventricular mass index and the IMT of the CCA were significantly greater than they were in control subjects (80 +/- 12 g/m2 and 0.45 +/- 0.05 mm in group I; 106 +/- 15 g/m2 and 0.57 +/- 0.08 mm in group II; and 122 +/- 17 g/m2 and 0.55 +/- 0.05 mm in group III). The mitral early:late peak flow velocity ratio was significantly lower in group II (1.9 +/- 0.58) than it was in the other two groups (2.3 +/- 0.66 in group I and 2.6 +/- 0.64 in group III). The results of our study suggest that both hypertension and physical training can induce parallel changes in cardiac and in arterial walls, and that physiological left ventricular hypertrophy in athletes is accompanied by a normal diastolic filling pattern in contrast to the pathological pattern found in hypertensives. Further investigation is required to explore possible differences in carotid structure and function between these two conditions.

Blood pressure and HDL-cholesterol cntributed to atherosclerosis of the carotid artery in hypertensive patients

Blood pressure and HDL-cholesterol cntributed to atherosclerosis of the carotid artery in hypertensive patients

Prevalence of atherosclerotic involvement of the internal carotid artery in hypertensive patients

The prevalence of atherosclerotic involvement of the internal carotid arteries, as diagnosed through an echo-Doppler imaging system with pulsed Doppler spectral analysis was evaluated in 49 hypertensives who had a negative history for neurological symptoms and 49 matched controls. The prevalence was 24.5% in the hypertensive group and 10.2% in the controls with a statistically significant difference (chi-square = 6.07, P < 0.01). Two hypertensives had severe stenosis (above 50% diameter reduction) and 7 had potentially embolic lesions (irregular surface, inhomogeneous appearance). No one of the matched controls was as severely involved. We conclude that arterial hypertension can account for enhanced prevalence of carotid artery disease in asymptomatic patients.