J Korean Soc Hypertens.  2011 Dec;17(4):177-184. 10.5646/jksh.2011.17.4.177.

Changes in Carotid Intima-media Thickness and Left Ventricular Mass by Control of Blood Pressure and Hyperlipidemia in Hypertensive Patients

• Sun BJ
• Kang DH
• Park GM
• Kim YG
• Hwang KW
• Cho SW
• Kim YR
• Kim DH
• Song JM
• Song JK

• KMID: 1492135
• DOI: http://doi.org/10.5646/jksh.2011.17.4.177

Abstract

BACKGROUND
Hypertensive patients often present with carotid atherosclerosis, and especially those with left ventricular hypertrophy (LVH) are known to have twice the prevalence of carotid atheroma. The aims of this study were to evaluate the changes in the severity of carotid atherosclerosis and left ventricular (LV) mass by control of blood pressure (BP) and hyperlipidemia in hypertensive patients.
METHODS
A total of 87 treated hypertensive patients who had been diagnosed as stage 2 hypertension on Joint National Committee 7 classification in past 1 year or LVH on electrocardiographic criteria were enrolled. Both at baseline and the end of study, repetitive measurements of carotid intima-media thickness (IMT) and LV mass indexed by body surface area were performed. Measurement of carotid IMT was conducted at bilateral sides of distal common carotid artery.
RESULTS
After the follow-up period of mean 16-months, there were significant lowering in systolic and diastolic BP, respectively (144.6 +/- 19.2 to 131.3 +/- 13.6 mm Hg, p < 0.001; 87.5 +/- 11.3 to 79.6 +/- 9.4 mm Hg, p < 0.001). Carotid IMT showed no significant change (0.75 +/- 0.18 to 0.76 +/- 0.18 mm, p = 0.310). Although there was significant reduction in LV mass index (107.9 +/- 22.0 to 101.0 +/- 18.4 g/m2, p < 0.001), it was not correlated with the changes in carotid IMT (r = 0.141, p = 0.197).
CONCLUSIONS
Anti-hypertensive therapy combined with statin if indicated did not show significant reduction in atherosclerotic burden of carotid artery, but it seemed to prevent further progression in hypertensive patients. Decrement in LV mass achieved by BP control was not correlated with changes in carotid IMT.

Keyword

Atherosclerosis; Left ventricular hypertrophy; Hypertension

MeSH Terms

Atherosclerosis
Blood Pressure
Body Surface Area
Carotid Arteries
Carotid Artery Diseases
Carotid Intima-Media Thickness
Electrocardiography
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hyperlipidemias
Hypertension
Hypertrophy, Left Ventricular
Joints
Plaque, Atherosclerotic
Prevalence
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Figure

• 

  Fig. 1. Correlation of change* in LV mass index with change† in carotid IMT (A), with baseline LV mass index (B). LV, left ventricle; IMT, intima-media thickness; BSA, body surface area. *†Value of follow-up minus baseline.

Reference

References

1. Cuspidi C, Negri F, Muiesan ML, Capra A, Lonati L, Milan A, et al. Prevalence and severity of echocardiographic left ventricular hypertrophy in hypertensive patients in clinical practice. Blood Press. 2010; 20:3–9.

2. Devereux RB, Roman MJ. Left ventricular hypertrophy in hypertension: stimuli, patterns, and consequences. Hypertens Res. 1999; 22:1–9.

3. Wachtell K, Bella JN, Liebson PR, Gerdts E, Dahlof B, Aalto T, et al. Impact of different partition values on preva-lences of left ventricular hypertrophy and concentric geometry in a large hypertensive population: the LIFE study. Hypertension. 2000; 35:6–12.

4. Roman MJ, Pickering TG, Schwartz JE, Pini R, Devereux RB. Association of carotid atherosclerosis and left ventricular hypertrophy. J Am Coll Cardiol. 1995; 25:83–90.

5. Polak JF, Pencina MJ, Pencina KM, O’Donnell CJ, Wolf PA, D’Agostino RB. Sr. Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med. 2011; 365:213–21.

6. Taylor AJ, Villines TC, Stanek EJ, Devine PJ, Griffen L, Miller M, et al. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med. 2009; 361:2113–22.

7. Sohn IS, Lee JB, Cho BH, Park JH, Jin ES, Cho JM, et al. Carotid intima-media thickness and arterial stiffness in hypertensive patients with first attack of ischemic stroke. J Korean Soc Hypertens. 2010; 16:14–21.

8. Jun HJ, Kim DS, Park YJ, Choi GN, Jang JH, Noh EJ, et al. The analysis with aortic stiffness, carotid intima-media thickness and aortic valve sclerosis according to existence and severity of coronary artery disease in hypertensive patients. J Korean Soc Hypertens. 2008; 14:19–27.

9. Taylor AJ, Kent SM, Flaherty PJ, Coyle LC, Markwood TT, Vernalis MN. ARBITER. Arterial biology for the investigation of the treatment effects of reducing cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation. 2002; 106:2055–60.

10. Devereux RB, Palmieri V, Liu JE, Wachtell K, Bella JN, Boman K, et al. Progressive hypertrophy regression with sustained pressure reduction in hypertension: the Losartan Intervention For Endpoint Reduction study. J Hypertens. 2002; 20:1445–50.

11. Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O’Leary DH, et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. JAMA. 2007; 297:1344–53.

12. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949; 37:161–86.

13. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289:2560–72.

14. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) . Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–421.

15. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008; 21:93–111.

16. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18:1440–63.

17. Pitt B, Byington RP, Furberg CD, Hunninghake DB, Mancini GB, Miller ME, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation. 2000; 102:1503–10.

18. Mochizuki S, Dahlof B, Shimizu M, Ikewaki K, Yoshikawa M, Taniguchi I, et al. Valsartan in a Japanese population with hypertension and other cardiovascular disease (Jikei Heart Study): a randomised, open-label, blinded endpoint morbidity-mortality study. Lancet. 2007; 369:1431–9.

19. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990. 322:p. 1561–6.

20. Gottdiener JS, Reda DJ, Massie BM, Materson BJ, Williams DW, Anderson RJ. Effect of single-drug therapy on reduction of left ventricular mass in mild to moderate hypertension: comparison of six antihypertensive agents. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Circulation. 1997; 95:2007–14.

21. Schmieder RE, Martus P, Klingbeil A. Reversal of left ventricular hypertrophy in essential hypertension. A meta-analysis of randomized double-blind studies. JAMA. 1996; 275:1507–13.