Hypertension status is the major determinant of carotid atherosclerosis - A community-based study in Taiwan

Background anti Purpose-Extracranial carotid artery (ECCA) atherosclerosis has been associated with hypertension-related stroke. The present study was aimed at investigating the determinants of ECCA atherosclerosis in patient s with hypertension in Taiwan. Methods-The extent and severity of ECCA atherosclerosis were measured by hi gh-resolution B-mode ultrasonography and expressed as maximal intima-media thickness (IMT) of the common carotid artery, ECCA plaque score, and caroti d stenosis greater than or equal to 50%. From July through December 1996, 2 63 hypertensive patients (146 with hypertension and 117 with borderline hyp ertension) and 270 normotensive adults from the Chin-Shan Community Cardiov ascular Cohort participated in this study. Risk factors and ECCA atheroscle rosis were stratified by the blood pressure status. Results-A significant dose-response relationship was found between the stat us of hypertension and the severity of carotid atherosclerosis. Multivariat e logistic regression models revealed that hypertension (including borderli ne), male gender, smoking, and age greater than or equal to 65 years signif icantly increased the risk of thicker MT. The risk of ECCA plaque score >6 increased significantly in conjunction with hypertension, age greater than or equal to 65 years, left ventricular hypertrophy on ECG, and smoking. How ever, hypertension and smoking were the 2 evident determinants of carotid s tenosis greater than or equal to 50% after adjustment for other covariates. Compared with the normotensive subjects, the ORs (and 95% CIs) for the hyp ertensive patients to develop carotid atherosclerosis were 5.0 (3.0 to 8.4) indexed by maximal common carotid artery IMT greater than or equal to 75th percentile, 3.7 (1.8 to 7.9) by ECCA score >6, and 4.8 (1.4 to 16.5) by ca rotid stenosis greater than or equal to 50%. Conclusions-Hypertension strongly influence carotid atherosclerosis. Our fi ndings reinforce the hypothesis that hypertension has a major role in the p athogenesis of atherosclerosis.