Prevalence of carotid atherosclerosis in middle-aged hypertensive and control subjects. A cross-sectional systematic study with duplex ultrasound

BACKGROUNDArterial hypertension has been found to increase atherosclerotic lesions, although contradictory results have suggested that hypertension has little or no effect. These discrepancies are probably caused by differences in populations. OBJECTIVETo examine the effect of hypertension on carotid atherosclerosis in a population-based series of patients with an established diagnosis of arterial hypertension and controls. METHODSCarotid intima-media thickness (IMT) and plaques were evaluated with duplex ultrasound in 1031 middle-aged (aged 40-60 years) men (n=511) and women (n=520), 513 with arterial hypertension and 518 controls. IMT was measured in the internal carotid artery, bifurcation and proximal, middle and distal common carotid artery, determining mean and maximal values for each patient. RESULTMale sex, age, smoking and cholesterol were the most significant risk factors for combined plaque and intima-media thickness (CPIMT); hypertension and an abnormal glucose test result were further significant risk factors. There was a significant difference in CPIMT between the hypertensive and control subjects, but this was caused by the differences in the men; there were no statistically significant differences among the women. Plaques were found more frequently in the hypertensive men than they were in their controls (62.8 versus 49.8%), the corresponding percentages for the hypertensive and control women being 38.0 and 32.1%. There was a larger proportion of male subjects with a long duration of hypertension (≥ 7 years) who had plaques and greater CPIMT than there was of those with a short duration of hypertension. CONCLUSIONHypertension had a significant effect on CPIMT and on the prevalence of plaques in men, but its effect in women was not significant. A long duration of hypertension resulted in greater CPIMT values and a higher prevalence of plaques, particularly in men.