|Year : 2016 | Volume
| Issue : 2 | Page : 48-51
Comparison of carotid intima-media thickness in hypertensive patients and control group
Ghodratollah Naseh1, Mahyar Mohammadi Fard2, Toba Kazemi3, AliReza Mirgholami2, Narges Hashemi4, Amin Saburi5
1 Department of Surgery, Birjand University of Medical Sciences, Birjand, Iran
2 Department of Radiology and Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran
3 Department of Cardiology, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran
4 Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
5 Department of Radiology and Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand; Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
|Date of Web Publication||9-Jun-2016|
Prof. Toba Kazemi
Atherosclerosis and Coronary Artery Research Center, Pasdaran Avenue, Birjand, South Khorasan
Source of Support: None, Conflict of Interest: None
Background: Hypertension (HTN), probably, is the most common public health problem among developed countries. Rapid diagnosis and effective treatment of HTN have not truly stopped the rapid rate of mortality and morbidity caused by HTN. Vascular wall changes are one of the most important and mortal complications of HTN. Ultrasonography was used for the evaluation of this vessel wall disorder by assessing the thickness of the intima and media layer. Objective: The objective of this study was to compare the Carotid intima Media Thickness (CIMT) in hypertensive patients and the control group. Methods: In a case-control study, 43 patients with documented primary HTN and 43 healthy subjects were assessed as control. Their HTN was controlled by the administration of drugs. The mean age was 53.9 years. The intima-media thickness (IMT) of internal and common carotid and outer vessel diameter were assessed by one radiologist. Results: CAIMT in all carotid arteries in the case group was more than that of the controls (P < 0.05). It was found that there was no difference between the length of having HTN and mean CAIMT in the hypertensive, except the right internal carotid (P = 0.024). Conclusion: The present study found that the mean CAIMT of all carotid arteries in HTN was more than that of the controls. Moreover, the duration of the HTN can accelerate the atherosclerosis process in hypertensive patients.
Keywords: Atherosclerosis, carotid intima-media thickness, hypertension, ultrasound
|How to cite this article:|
Naseh G, Fard MM, Kazemi T, Mirgholami A, Hashemi N, Saburi A. Comparison of carotid intima-media thickness in hypertensive patients and control group. J Cardiovasc Echography 2016;26:48-51
|How to cite this URL:|
Naseh G, Fard MM, Kazemi T, Mirgholami A, Hashemi N, Saburi A. Comparison of carotid intima-media thickness in hypertensive patients and control group. J Cardiovasc Echography [serial online] 2016 [cited 2021 Oct 22];26:48-51. Available from: https://www.jcecho.org/text.asp?2016/26/2/48/183749
| Introduction|| |
Cardiovascular diseases are the most common causes of death in the world. In Iran, these diseases are ranked first as the leading cause of mortality.  Hypertension (HTN) is the most common cause of visiting physicians and one of the most prevalent cardiac risk factors; and if properly diagnosed and controlled, it is possible to prevent serious complications such as ischemic heart disease, heart failure, stroke, and renal failure. 
The arterial capacity in resistant artery is a decisive factor of arterial pressure. In hypertensive patients, functional, mechanical, and structural changes cause a decrease in the diameter of arteries. These changes increase systolic pressure, pulse pressure, and stiffness of arteries. 
In current studies, arterial stiffness is dealt with as an independent predisposing factor for cardiovascular accident; there are different processes to assess systemic regional stiffness. One of the valuable techniques in the estimation of carotid artery stiffness is ultrasonography. 
Ultrasonography is a cheap, easy, and noninvasive method through which intima-media thickness (IMT) is measured.  Various studies have been conducted to measure IMT in diabetics, obese patients, and patients with renal diseases and dyslipidemia. ,
Since racial, geographical, and cultural differences are decisive in both HTN and IMT, it was decided to carry out a comparative study of IMT in HTN and healthy individuals in Birjand in 2010.
| Methods|| |
The present case-control study was conducted in Birjand, Imam Reza Hospital in 2010. The cases were 43 primary hypertensive patients who had suffered the condition, at least, for 5 years. Their hypertensive condition was controlled by the administration of drugs. The patients were selected from those referred to the cardiology wards of Vali-e-asr Hospital. The controls were selected from patients referred to other clinics of the Vali-e-asr Hospital.
The controls were healthy and did not have a history of HTN. The two groups (i.e., cases and controls) were matched regarding age and sex. The subjects gave their consent by writing and entered the study, after being justified. The exclusion criteria included diabetes, renal disease, secondary HTN, dyslipidemia, cardiac or cerebral disease, and cigarette smoking.
The blood pressure (BP) of members of both groups was taken while they were in the sitting position, applying the right hand by means of a mercury sphygmomanometer. The BP of every one was consecutively taken twice, at an interval of 10 min in-between, and the average pressure obtained was recorded as BP.
Weight (W) and height (H) were measured using standard methods, and body mass index (BMI) was calculated on the basis of the following formula: BMI = weight (kg)/height (m 2 ).
A research-designed checklist consisting of demographic information was filled out, for each subject, by the researcher. Then, both group members were referred to a radiologist for the measurement of carotid IMT (CAIMT).
An ultrasound linear probe with 8 MHZ resolution (Medison Tech Company, South Korea) was used for measuring the CAIMT.
Finally, the obtained data were analyzed using the SPSS software, SPSS, Inc, Chicago, IL, USA, at a significance level of α <0.05.
| Results|| |
In the present study, 43 primary HTN patients whose conditions were under control and 43 healthy individuals, after being matched with respect to age and sex, were compared regarding CAIMT.
[Table 1] presents the demographic information of the patients. As it is evident in the table, mean serum glucose and lipid in both groups were the same, but mean BMI of the case group was significantly higher than that of the control.
The mean CAIMT in both groups is compared in [Table 2]. According to the table, the mean CAIMT in all carotid arteries in the case group was more than that of the controls.
The mean CAIMT in HTN, regarding length of having the disease, is shown in [Table 3]. It was found that there was no difference between the length of having HTN and mean CAIMT in the hypertensive patients.
|Table 3: The carotid intima-media thickness according to the duration of the disease |
Click here to view
| Discussion|| |
HTN is one of the serious risk factors of cardiac diseases and it causes the death of about 50% of patients with coronary artery diseases and heart failure, if untreated.
Increasing CAIMT is an independent risk factor and a measurable one in the diagnosis of subclinical atherosclerosis. In the present study, a comparative study of CAIMT in controlled primary HTN and in healthy individuals was dealt with, and CAIMT was found to be directly related to age.  However, the mean CAIMT is higher than that of women of the same age. However, after menopause, the rate of CAIMT increase is more in women.  This was why the patients were matched regarding age and sex in the current study.
The present study found that mean CAIMT of all carotid arteries in HTNs was more than that of the controls. In Tachiuchi's study, 25 normotensives and 140 HTNs were assessed. The aim of the research was to study the relationship between cardiac flow reserves (CFRs) and CAIMT. Results indicated that the CFR was significantly less in the HTN and there was a reverse relationship between CAIMT and CFR, but the common CIMT was a strong and independent parameter in the prognosis of CFR in HTN. 
In his study, Sasaki compared the CAIMT of 163 untreated primary HTN and that of 76 normotensives. It was found that CAIMT in the patients was significantly higher than that of the controls and in both groups, there was an increase in age. The results of this study are similar to those of the present one.  According to Sasaki, vascular remodeling is the cause of carotid arterial changes. In the early atherosclerosis stages, a compensatory mechanism prevents narrowing coincident with an increase in IMT, which occurs during the early phase. Although it is a compensatory mechanism, hemodynamic changes still occur in the walls of the arteries resulting in arterial disease. 
In his study, Chironi compared IMT in the right common carotid in 394 healthy individuals with that of 327 uncontrolled HTN and 528 controlled HTN. The results of the study showed that CAIMT in both patient groups, not accounting for any treatment, was higher than that of the healthy group.  The present study which was only conducted on treated HTN had similar results.
Based on our study, the right and left common and internal carotid arteries in HTN was significantly higher compared to healthy individuals.
In Andrew's study on 6975 individuals aged 19-90 years, it was found that the mean development of IMT in the internal carotid was significantly higher in comparison with that of the common carotid and carotid bifurcation spot. This study proved that only the IMT of the common internal carotid had a significant relationship with arterial risk factors such as age, sex, HTN, diabetes, and smoking. 
In the study of Liang et al. on 372 smokers and 307 hypertensive nonsmokers, CAIMT was measured. The obtained data showed that both smoking and HTN increased IMT; but HTN, by itself, increased the IMT/Lumen ratio, while smoking had no effect on this ratio. 
On the basis of the present study, no relationship was observed between the length of HTN and IMT; something that may be due to the fact that all our patients had, at least, a history of 5 years of HTN.
| Conclusion|| |
IMT in the carotid arteries of HTN is more than that of healthy individuals. This condition can be a sign of subclinical atherosclerosis.
The main limitation of the study was the small number of samples, although patients were matched in regard to age, sex, and heart risk factors; and at least, they had a hypertension history of 5 years behind.
It is noteworthy that the present study was done in the cardiology ward of the Vali-e-asr Hospital. Patients from all parts of the city were referred to this ward.
The second limitation was that the hypertension was in a more obese state, since obesity has a relationship with CAIMT; if the two groups (case and control) had the same BMI, the situation would have been better.
The last limitation of the present study was that medical treatment administered to hypertension was not taken into account.
This article was written in partial fulfillment of an MD thesis of medical student (Narges Hashemi) registered at Birjand University of Medical Sciences.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kazemi T, Sharifzadeh GR, Zarban A, Fesharakinia A, Rezvani MR, Moezy SA. Risk factors for premature myocardial infarction: A matched case-control study. J Res Health Sci 2011;11:77-82.
Persell SD. Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension 2011;57:1076-80.
Noohi F, Sarrafzadegan N, Khosravi A, Andalib E; First Recommendation on High Blood Pressure Working Group. The first Iranian recommendations on prevention, evaluation and management of high blood pressure. ARYA Atheroscler 2012;8:97-118.
Jaroch J, Loboz Grudzien K, Bociaga Z, Kowalska A, Kruszynska E, Wilczynska M, et al.
The relationship of carotid arterial stiffness to left ventricular diastolic dysfunction in untreated hypertension. Kardiol Pol 2012;70:223-31.
Su TC, Chien KL, Jeng JS, Chen MF, Hsu HC, Torng PL, et al.
Age- and gender-associated determinants of carotid intima-media thickness: A community-based study. J Atheroscler Thromb 2012;19:872-80.
Takiuchi S, Rakugi H, Fujii H, Kamide K, Horio T, Nakatani S, et al.
Carotid intima-media thickness is correlated with impairment of coronary flow reserve in hypertensive patients without coronary artery disease. Hypertens Res 2003;26:945-51.
Sasaki R, Yamano S, Yamamoto Y, Minami S, Yamamoto J, Nakashima T, et al.
Vascular remodeling of the carotid artery in patients with untreated essential hypertension increases with age. Hypertens Res 2002;25:373-9.
Chironi G, Gariepy J, Denarie N, Balice M, Megnien JL, Levenson J, et al.
Influence of hypertension on early carotid artery remodeling. Arterioscler Thromb Vasc Biol 2003;23:1460-4.
Mackinnon AD, Jerrard-Dunne P, Sitzer M, Buehler A, von Kegler S, Markus HS. Rates and determinants of site-specific progression of carotid artery intima-media thickness: The carotid atherosclerosis progression study. Stroke 2004;35:2150-4.
Liang YL, Shiel LM, Teede H, Kotsopoulos D, McNeil J, Cameron JD, et al
. Effects of blood pressure, smoking, and their interaction on carotid artery structure and function. Hypertension 2001;37:6-11.
[Table 1], [Table 2], [Table 3]