What measure of carotid wall thickening is the best atherosclerotic loading score in the hypertensive patient: maximum or mean value?

Recent guidelines on arterial hypertension regard increased carotid intima-media thickness (IMT) as a marker of end-organ damage. However, these guidelines do not specify whether the maximum or mean IMT should be used as an indicator. The aim of this study was to compare these two measures and their relationship to atherosclerotic burden. The study involved 215 consecutive hypertensive patients who were divided into three groups according to their IMT: maximum IMT>0.9mm (with mean IMT<0.9mm); mean IMT>0.9mm (i.e. mean and maximum IMT>0.9mm); and normal IMT. Patients with a pathologically raised IMT (whether maximum or mean value) were more likely to be dyslipidemic, were older, had a longer history of hypertension, and had a poorer glomerular filtration rate and ankle-brachial index. Patients with a mean IMT>0.9mm were more likely to have carotid plaque, carotid stenosis and a low ankle-brachial index than those with a maximum IMT>0.9mm. The mean IMT provided a better indication of atherosclerotic burden in patients with hypertension.