Impact of prehypertension on carotid artery intima-media thickening: actual or masked?
BACKGROUND
Recent studies have reported that prehypertension is associated with increased values of common carotid artery intima-media thickness (CCA-IMT). The aim of this study was to assess the impact of daytime ambulatory blood pressure (BP) levels on the association of prehypertension with CCA intima-media thickening in prehypertensive subjects.


METHODS
A total of 807 subjects with office systolic BP<140 and diastolic BP<90mmHg, underwent 24h ambulatory BP (ABP) monitoring and carotid artery ultrasonographic measurements. The study population was divided into 3 groups according to office and daytime ABP levels: (1) normotensives: subjects with office BP<120/80mmHg and daytime ambulatory BP values within the normal range, (2) actual prehypertensives: individuals with office SBP (120-139mmHg) and/or DBP (80-89mmHg) and daytime ambulatory BP values within the normal range and (3) prehypertensives with masked hypertension (MH): patients with office SBP (120-139mmHg) and/or DBP (80-89mmHg) and elevated daytime ambulatory BP values.


RESULTS
Prehypertensive patients with MH had higher (p<0.01) CCA-IMT values (0.712mm; 95%CI: 0.698-0.725) than actual prehypertensives (0.649mm; 95%CI: 0.641-0.656) and normotensives (0.655mm; 95%CI: 0.641-0.670) even after adjustment for baseline characteristics. Normotensives and actual prehypertensives did not differ significantly regarding CCA-IMT values (p>0.05). After adjusting for potential confounders, (including demographic characteristics, vascular risk factors, and office BP) prehypertension with MH was independently (p<0.01) associated with a 0.06mm increment in CCA-IMT (95%CI: 0.03-0.09).


CONCLUSIONS
Patients with office BP levels in the prehypertensive range, who also have elevated daytime ABP levels, had higher CCA-IMT values than patients with prehypertension with normal daytime ABP values and normotensive individuals.
Department of Clinical Therapeutics, University of Athens, Ierolochiton 60, 12244 Athens, Greece. stathismanios@yahoo.gr
Efstathios
E
Manios
Fotios
F
Michas
Georgios
G
Tsivgoulis
Kimon
K
Stamatelopoulos
Georgios
G
Tsagalis
Eleni
E
Koroboki
Eleftheria
E
Alexaki
Christos
C
Papamichael
Konstantinos
K
Vemmos
Nikolaos
N
Zakopoulos
D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002339:Carotid Arteries / Q000378:metabolism / Q000473:pathology*; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D013599:Systole; D017539:Tunica Intima / Q000503:physiopathology*; D017540:Tunica Media / Q000503:physiopathology*; D014463:Ultrasonography / Q000379:methods