title: Alterations of carotid arterial mechanics preceding the wall thickening in patients with hypertension.
abstract: OBJECTIVE
  Carotid intima-media thickness (cIMT) is an established surrogate marker of atherosclerosis. However, cIMT may not reflect the whole arterial changes occurring in various pathologic conditions, such as hypertension. The aim of this study was to evaluate whether vascular properties of carotid artery (CA) in patients with hypertension differ from those of patients with diabetes and controls before the progression of cIMT.
  
  
  METHODS
  Vascular properties of CA were assessed in 402 consecutive asymptomatic subjects who have normal cIMT (131 with hypertension, 151 with diabetes mellitus, and 120 controls). Conventional carotid stiffness indices calculated from vessel diameter and blood pressure, and parameters from velocity-vector imaging (VVI), including vessel area, fractional area change (FAC), radial velocity, circumferential strain, and strain rate were measured to assess the differences between the groups.
  
  
  RESULTS
  In univariate analysis, both patients with hypertension and diabetes showed higher elastic modulus, lower distensibility coefficients and FAC of VVI than those of controls. However, when adjusting for baseline covariates, only FAC (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.70-0.97, p = 0.025) and vessel area (OR = 2.84, 95% CI = 1.64-4.91, p < 0.001) discriminated CA of patients with hypertension from those of controls. Also, patients with hypertension showed larger vessel area than diabetes (OR = 2.58, 95% CI = 1.75-3.80, p < 0.001) independent of baseline covariates. No significant vascular parameter was found to discriminate patients with diabetes from controls after adjustments.
  
  
  CONCLUSIONS
  Despite normal cIMT, the CA of hypertensive patients was stiffer than those of controls and positive remodeling preceded the wall thickening independent of baseline covariates.
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Sung-Ai
authors.initials: SA
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Jo
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Kyoung-Ha
authors.initials: KH
authors.lastname: Park
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Sang-Jin
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Woo-Jung
authors.initials: WJ
authors.lastname: Park
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: jwha@yuhs.ac.
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D001794:Blood Pressure; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000378:metabolism; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D015203:Reproducibility of Results; D012307:Risk Factors; D014463:Ultrasonography; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers
keywords: Carotid intima-media thickness; Diabetes; Hypertension; Stiffness; Vascular property