title: Development of new atherosclerotic plaque in hypertensive patients: an observational registry study from the Campania-Salute network.
abstract: OBJECTIVE
  Carotid atherosclerotic plaques (CAPs) can develop despite appropriate antihypertensive therapy. In this observational study, we assessed characteristics associated with risk of incident CAP in a large hypertensive registry.
  
  
  METHODS
  We evaluated 2143 hypertensive patients without evidence of CAP. Incident CAP was censored at the time of the first ultrasound control in which CAP was detected. CAP was defined according to European Society of Hypertension/European Society of Cardiology guidelines.
  
  
  RESULTS
  At a median follow-up period of 56.6 months, about one-third of patients (32%; N = 688) exhibited new CAP. Those patients were older, more frequently smokers, diabetic, more often with metabolic syndrome, chronic kidney disease (CKD), longer hypertension history, higher baseline SBP, pulse pressure (PP), fasting glucose, total cholesterol and triglycerides, greater left ventricular mass index, higher PP/stroke index ratio and carotid intima-media thickness (IMT; all P < 0.05). In-treatment BP control was similar in both groups. In multivariable Cox regression, CAP was predicted by older age, diabetes, smoking habit, CKD and higher value of initial IMT (all P < 0.02), independently of BP control during follow-up, antihypertensive therapy and other confounders.
  
  
  CONCLUSIONS
  In this registry of treated hypertensive patients, after adjusting for age and other confounders, risk of incident CAP did not depend on BP control and type of antihypertensive therapy, whereas it was independently related to the magnitude of initial IMT, independently of significant effect of prevalent diabetes and smoking habit. These findings suggest that antihypertensive treatment strategy to stop progression of cardiovascular disease might be difficult to achieve, once target organ damage is established.
authors.affiliation: aHypertension Research Center bDepartment of Translational Medical Sciences cDepartment of Advanced Biomedical Sciences dDepartment of Neurosciences, Federico II University, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Izzo
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
authors.forename: Valentina
authors.initials: V
authors.lastname: Trimarco
authors.forename: Flora Ilaria
authors.initials: FI
authors.lastname: Laurino
authors.forename: Maria Assunta Elena
authors.initials: MA
authors.lastname: Rao
authors.forename: Marina
authors.initials: M
authors.lastname: De Marco
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Losi
authors.forename: Nicola
authors.initials: N
authors.lastname: De Luca
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
mesh_terms: D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents