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(Stroke. 2001;32:2265.)
© 2001 American Heart Association, Inc.
Original Contributions |
Hypertension Status Is the Major Determinant of Carotid Atherosclerosis
A Community-Based Study in Taiwan
From the Departments of Internal Medicine (T.-C.S., K.-L.C., H.-C.H., Y.-T.L.) and Neurology (J.-S.J.), National Taiwan University Hospital, and College of Public Health (F.-C.S.), National Taiwan University, Taipei, Taiwan.
Correspondence and reprint requests to Yuan-Teh Lee, MD, PhD, FACC, Professor, Internal Medicine, College of Medicine, National Taiwan University, and Superintendent of National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10020, Taiwan. E-mail ytlee{at}ha.mc.ntu.edu.tw
Background and Purpose—— Extracranial carotid artery (ECCA) atherosclerosis has been associated with hypertension-related stroke. The present study was aimed at investigating the determinants of ECCA atherosclerosis in patients with hypertension in Taiwan.
Methods—— The extent and severity of ECCA atherosclerosis were measured by high-resolution B-mode ultrasonography and expressed as maximal intima-media thickness (IMT) of the common carotid artery, ECCA plaque score, and carotid stenosis 
50%. From July through December 1996, 263 hypertensive patients (146 with hypertension and 117 with borderline hypertension) and 270 normotensive adults from the Chin-Shan Community Cardiovascular Cohort participated in this study. Risk factors and ECCA atherosclerosis were stratified by the blood pressure status.
Results—— A significant dose-response relationship was found between the status of hypertension and the severity of carotid atherosclerosis. Multivariate logistic regression models revealed that hypertension (including borderline), male gender, smoking, and age 65 years significantly increased the risk of thicker IMT. The risk of ECCA plaque score >6 increased significantly in conjunction with hypertension, age 65 years, left ventricular hypertrophy on ECG, and smoking. However, hypertension and smoking were the 2 evident determinants of carotid stenosis 50% after adjustment for other covariates. Compared with the normotensive subjects, the ORs (and 95% CIs) for the hypertensive patients to develop carotid atherosclerosis were 5.0 (3.0 to 8.4) indexed by maximal common carotid artery IMT 75th percentile, 3.7 (1.8 to 7.9) by ECCA score >6, and 4.8 (1.4 to 16.5) by carotid stenosis 50%.
Conclusions—— Hypertension strongly influence carotid atherosclerosis. Our findings reinforce the hypothesis that hypertension has a major role in the pathogenesis of atherosclerosis.
Key Words: Atherosclerosis • Carotid arteries • Hypertension • Taiwan
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