Carotid Intima-media Thickness In Hypertensive Patients Research Articles

The Relationship between Uric Acid/Albumin Ratio and Carotid Intima-Media Thickness in Patients with Hypertension.

Hypertension causes subendothelial inflammation and dysfunction in resulting atherosclerosis. Carotid intima-media thickness (CIMT) is a useful marker of endothelial dysfunction and atherosclerosis. The uric acid to albumin ratio (UAR) has emerged as a novel marker for predicting cardiovascular events. We aimed to investigate the association of UAR with CIMT in hypertensive patients. Two hundred sixteen consecutive hypertensive patients were enrolled in this prospective study. All patients underwent carotid ultrasonography to classify low (CIMT < 0.9 mm) and high (CIMT ≥ 0.9 mm) CIMT groups. The predictive ability of UAR for high CIMT was compared with systemic immune inflammation index (SII), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR). A two-sided p-value <0.05 was accepted as statistically significant. Patients with high CIMT were older and had higher UAR, SII, NLR, and CAR than low CIMT. Age, UAR, SII, NLR, and CAR, but not PLR, were associated with high CIMT. In multivariable analysis, age, CRP, SII, and UAR were independent predictors of high CIMT. The discrimination ability of UAR was higher than uric acid, albumin, SII, NLR, and CAR, and UAR had a higher model fit than those variables. UAR had higher additive improvement in detecting high CIMT than other variables, as assessed with net-reclassification improvement, IDI, and C-statistics. UAR was also significantly correlated with CIMT. UAR might be used to predict high CIMT and might be useful for risk stratification in hypertensive patients.

10 A NOVEL PEPTIDE ELABELA IS ASSOCIATED WITH HYPERTENSION-RELATED SUBCLINICAL ATHEROSCLEROSIS

Background: Elabela is a newly identified peptide which, alongside apelin, acts as an endogenous ligand that activates the angiotensin receptor-like 1 receptor (APJ). Previous clinical studies have shown the association of elabela with hypertension, but information about the role of elabela in hypertension-related atherosclerosis is scarce. Objectives: To determine the association between plasma elabela peptide levels and subclinical atherosclerosis in the hypertensive population. Methods: A total of 104 subjects with hypertension were included in a cross-sectional study. Plasma elabela levels were measured using enzyme-linked immunosorbent assay (ELISA) by extracting the peptide following the manufacturer's instructions. The subclinical atherosclerosis parameter was assessed by measuring the carotid intima-media thickness (IMT) using ultrasound. Results: Compared to stage 1, elabela levels decreased in stage 2 of the hypertension group (0.14 [0.09, 0.23] ng/ml vs. 0.23 [0.13, 0.45] ng/ml; P = 0.000), and in the group with increased carotid IMT compared to normal IMT (0.15 [0.10, 0.23] ng/ml vs. 0.24 [0.13, 0.38] ng/ml; P = 0.005). Additionally, a linear correlation analysis showed that elabela had a significant negative correlation with systolic blood pressure (r = -0.340, P = 0.000) and carotid IMT (r = -0.213; P = 0.030). In multivariate analysis, decreased elabela levels (cut-off 0.155 ng/ml) were associated with the higher cardiovascular risk group in this study (OR 5.0, 95% CI 1.8-13.5, P &lt; 0.001). Conclusion: This study is the first to demonstrate the association of circulating elabela with carotid IMT in hypertensive patients, implicating that elabela is involved in the pathogenesis of hypertension-related subclinical atherosclerosis. Reduced elabela levels were also associated with increased cardiovascular risk.

Systemic immune-inflammation index is associated with increased carotid intima-media thickness in hypertensive patients

ABSTRACT Background Arterial hypertension causes cardiovascular adverse events mainly through endothelial dysfunction, atherosclerosis, and inflammation. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and endothelial dysfunction. Systemic immune-inflammation index (SII) reflects systemic inflammatory and immunity status. This index has strong prognostic value in malignancy and recently was demonstrated to be associated with adverse events in cardiovascular diseases. We aimed to interrogate the relationship between SII and CIMT in patients with hypertension. Methods A total of 215 consecutive hypertensive patients were included in the study. CIMT of all patients was obtained by B-mode arterial doppler ultrasound. SII was obtained by the following formula: (platelet × neutrophil/lymphocyte ratio) from admission complete blood count. Patients were divided into two groups by means of CIMT is above or below the value of 0.9 mm. SII and demographic characteristics of patients were compared between groups. Results Increased CIMT was detected in 55 (25.6%) of hypertensive patients. The patients with increased CIMT were older and had higher neutrophil count (p < .001), neutrophil to lymphocyte ratio (NLR) (p < .001), C-reactive protein (CRP) (p = .047), CRP to albumin ratio (CAR) (p = .044) and SII (p < .001) Advanced age (OR: 1.054; 95% CI: 1.015–1.095; p = .006), NLR (OR: 3.213; 95% CI: 1.577–6.546; p = .001), and SII (OR: 3.906; 95% CI: 1.887–8.086; p < .001) were independent predictors of increased CIMT in multivariable logistic regression analysis. Conclusion SII was an independent predictor of elevated CIMT in hypertensive patients. Preventive approaches for future atherosclerotic cardiovascular diseases can be developed in those with higher SII level.

Positive relationship of hypertensive retinopathy with carotid intima--media thickness in hypertensive patients.

We aimed to explore the relationship of hypertensive retinopathy with carotid intima--media thickness (CIMT), and to examine the possible effect modifiers in Chinese adults with hypertension. We conducted a cross-sectional study of 12 342 hypertensive patients with complete exit site visit data from the China Stroke Primary Prevention Trial. CIMT was measured by carotid ultrasonography. Hypertensive retinopathy was diagnosed according to the Keith--Wagener--Barker classification. The mean (SD) CIMT among study participants was 739.9 (111.4) μm. Compared with patients with grade 1 hypertensive retinopathy or without hypertensive retinopathy, a significantly higher CIMT level (β, 7.63, 95% CI: 2.54--12.73) was observed in patients with grade 2-4 hypertensive retinopathy. Moreover, the association between hypertensive retinopathy (grade 2-4 versus grade 1 or normal) and CIMT was stronger in participants of younger age (<60 years; β, 13.70, 95% CI: 5.65--21.75; versus ≥60 years; β, 1.03, 95% CI: -5.58 to 7.63; P interaction = 0.006); or with lower total homocysteine levels [<12.1 μmol/l (median); β, 12.70, 95% CI: 5.98--19.42; versus ≥12.1 μmol/l; β, 2.07, 95% CI: -5.63 to 9.78; P interaction = 0.030). None of the other variables, including sex, BMI, study centers, treatment group, SBP, triglycerides, total cholesterol, fasting blood glucose, folate, serum creatinine, current smoking and alcohol drinking, significantly modified the relation of hypertensive retinopathy with CIMT levels. Hypertensive retinopathy (grade 2 and higher) was significantly associated with increased CIMT in hypertensive patients. The association was stronger in those of younger age or with lower total homocysteine levels.

Carotid intima media thickness in relation with blood pressure and body mass index in hypertensive patients

Background: Hypertension will causes structural changes of intima media of large vessels which further causes atheroma formation. Arterial wall thickness can be measured by B-mode ultrasonic measurements of carotid intima media thickness (CIMT) and the extent of carotid atherosclerotic vascular disease may be estimated. The test measures the thickness of the inner two layers of the carotid artery, the intima and the media. Methods: A cross sectional study carried out over a 2 year period. 120 in which 60 are normal healthy individuals and 60 are Hypertensive patients with 3 grades. In all the participants BMI, Blood Pressure and CIMT were measured. Results: In the present study systolic and diastolic blood pressure was significantly increased in hypertension patients compared with Control. The Carotid Intima Media Thickness (CIMT) both Left and Right side were significant higher in Hypertension patients when compared with Control. Blood pressure which includes Systolic and Diastolic blood pressure was positively correlated with cardio vascular risk factor CMIT and it is statistically significant. Conclusion: Present study finding suggested that there is a raised value of CIMT in hypertensive patients. Using CIMT with ultrasonography is a cost effective, noninvasive, easy and reproducible and help as warning signal.

Association of serum proprotein convertase subtilisin/kexin type 9 with carotid intima media thickness in hypertensive subjects

ObjectiveThe clinical significance of the measurement of serum PCSK9 (proprotein subtilisin kexin type 9) is not well defined. This study investigated the association between serum PCSK9 levels and atherosclerosis assessed by carotid intima media thickness (IMT) in hypertensive patients. MethodsA total of 126 hypertensive patients over the age of 45 were enrolled. The maximum carotid IMT (max-IMT) and the mean carotid IMT (mean-IMT) were measured at the time of enrollment. Clinical and laboratory parameters including serum PCSK9 were analyzed. ResultsPatients were divided into tertiles based on serum PCSK9 levels. After adjusting for age, sex, total cholesterol, HDL-cholesterol and triglyceride, max-IMT was significantly increased in the highest tertile of serum PCSK9 (0.969±0.033 vs 0.959±0.033 vs 1.077±0.033mm, respectively; P=0.026). Mean-IMT showed a tendency to increase across the tertile groups (0.773±0.025 vs 0.790±0.026 vs 0.856±0.025mm, respectively; P=0.059). Multivariate regression analysis revealed that serum PCSK9 was independently associated with carotid IMT (max-IMT: β=0.212, P=0.016; mean-IMT: β=0.184, P=0.04). ConclusionThe present study is the first to report the association between serum PCSK9 levels and carotid IMT in hypertensive patients. These results suggest that serum PCSK9 may have a certain role in early pathogenesis of atherosclerosis.

Relationship of oxidized low density lipoproteins to carotid artery intima-media thickness in hypertensive patients.

Oxidation of LDL plays an important role in the pathogenesis of atherosclerosis. Increased wall thickness precedes plaque formation and noninvasive B-mode ultrasonographic measurement of IMT is considered a useful marker of the development of the carotid atherosclerosis. The present study was designed to assess the association of oxidized low-density lipoprotein (ox-LDL) with carotid intima-media thickness (IMT) in hypertensive patients. Oxidized LDL (enzyme-linked immunosorbent assay, Elisa) and carotid IMT (high-resolution B-mode ultrasonography) were assessed in 74 patients, aged between 45 and 65 years, diagnosticated with arterial hypertension. We observed significantly higher plasma levels of total cholesterol (236.32 mg %), LDL cholesterol (166.92 mg %), triglycerides (180.79 ± 72.05mg %) and low plasma levels of HDL-cholesterol (33.24 ± 7.99 mg %) in all patients. We noticed higher plasma levels of ox-LDL (77.34 mg %) and carotid IMT was increased (1.41 ± 0.31 mm). The statistically analysis done using Pearson’s test and Student’s t – test indicated that there were correlations of ox-LDL with: IMT (p < 0.05, r=0.408), total cholesterol (p <0.05, r=0.498), LDL-cholesterol (p < 0.05, r= 0.527), triglycerides (p <0.05, r=) and HDL-cholesterol (p< 0.05, r = -0.442). In conclusion, higher plasma levels of ox-LDL were associated with increased carotid IMT in hypertensive patients. Measurement of plasma Ox-LDL and carotid IMT may represent useful markers for atherosclerosis and may represent potential targets for therapeutic interventions.

Uric acid level and its association with carotid intima–media thickness in patients with hypertension

Objective Carotid intima–media thickness (C-IMT) measured noninvasively by ultrasonography is now widely used as a surrogate marker for atherosclerotic disease and directly associated with increased risk of cardiovascular disease. Hyperuricemia (HU) is a well recognized risk factor for cardiovascular diseases. The independence of this association from other confounding factors has remained controversial. But the possible contributory effect of HU to carotid intima–media thickness (C-IMT) produced by hypertension (HT) has not been clarified yet. The study was designed to assess the C-IMT in patients with hypertension (HT) with or without HU. Methods The study participants consisted of 30 patients (men 60%, mean age ± S.D.: 49 ± 11 years) with HT without HU, and 25 patients with HT and HU (men 52%, mean age ± S.D.: 52 ± 12 years), and 25 age-matched healthy control subjects (men 56%, mean age ± S.D.: 50 ± 13 years). All study groups were examined by B-mode ultrasound to measure the C-IMT at the far wall of the common carotid artery. Results C-IMT were significantly higher in the patient groups (HT without HU and HT with HU) compared to the control cases (0.70 ± 0.14, 0.83 ± 0.16 versus 0.57 ± 0.16, mm, respectively, p < 0.001). In the patients groups, patients with HU had significantly higher carotid IMT compared to the patients without HU. In stepwise linear regression analysis, we found that serum uric acid (SUA) levels independently but modestly associated with C-IMT ( β = 0.42, p = 0.002). Conclusion We have shown that higher SUA levels are associated with atherogenesis independent from hypertension. Prospective studies will be necessary to confirm and extend these findings including early screening for hyperuricemia and lowering of SUA level looking at potential benefits in slowing progression of C-IMT in hypertensive patients.

Influence of age, body mass index, and blood pressure on the carotid intima-media thickness in normotensive and hypertensive patients

We investigated whether body mass index and blood pressure have an additive influence on the carotid intima-media thickness (IMT). In 27 patients treated for hypertension (47.2+/-8.7 years) and 23 normotensive subjects (44.1+/-8.1 years), 24-h recording of blood pressure was performed. The carotid IMT was determined by ultrasonography and baroreflex sensitivity by a spectral method from 5-min recordings of blood pressure. Significant differences between hypertensive and normotensive subjects were observed for carotid IMT (0.60+/-0.08 vs. 0.51+/-0.07 mm; p<0.001) and baroreflex sensitivity (3.5+/-1.8 vs. 5.6+/-2.1 ms/mm Hg; p<0.001). Hierarchical multiple regression analysis (p<0.01) showed that carotid IMT was positively correlated with age (p<0.001) and body mass index (p<0.05) in normotensive subjects. The increased carotid IMT in hypertensive patients was not additively influenced by either age or body mass index. Baroreflex sensitivity decreased with age (p<0.01) and with carotid IMT (p<0.05) in normotensive subjects only. Multiregression analysis showed that an additive influence of age and body mass index on the development of carotid IMT is essential only in normotensive subjects. In hypertensive subjects the influence of blood pressure predominates, as documented by a comparison of the carotid IMT between hypertensive and normotensive subjects.

Glucose level is a major determinant of carotid intima-media thickness in patients with hypertension and hyperglycemia.

A causal relationship has been established between hyperglycemia and cardiovascular diseases, but no threshold has been retained to determine a 'glycemia-associated' cardiovascular risk. Carotid intima-media thickness (CIMT) is an independent predictor for cardiovascular events. High blood pressure is a major determinant of CIMT. To determine the influence of fasting glycemia on CIMT in hypertensive patients with either normal fasting glucose, impaired fasting glucose (IFG) or type 2 diabetes (DM-2). We included 158 essential hypertensive patients with either normal fasting glucose (n=74), IFG (n=24) or DM-2 (n=60) in a cross-sectional study. Common carotid IMT was measured with a high resolution echotracking system. CIMT of DM-2 patients was significantly higher than that of IFG and normal fasting glucose patients (809 +/- 180, 697 +/- 151 and 689 +/- 134 microm, respectively; analysis of variance (ANOVA) P <0.0001). In multivariate analysis in normal fasting glucose patients, local pulse pressure and age were the major determinants of CIMT, whereas glycemia was not. In IFG and DM-2 patients, fasting glycemia was strongly associated with CIMT, explaining 21 and 18% of its variance, respectively. Particularly, in IFG patients, an increase in 1 mmol/l glycemia was associated with a 165 microm increase in CIMT. In hyperglycemic patients, with either IFG or DM-2, age was an important determinant of CIMT, whereas local pulse pressure was not. These data suggest that glycemia is a major independent determinant of CIMT in hypertensive hyperglycemic patients, not only in DM-2 patients but also at the earlier stage of IFG, offsetting the mechanical role of local pulse pressure.