Circulation, Vol 86, 1909-1918, Copyright © 1992 by American Heart Association
MJ Roman, PS Saba, R Pini, M Spitzer, TG Pickering, S Rosen, MH Alderman and RB Devereux
BACKGROUND. Although vascular damage in the noncoronary circulation is a
major cause of complications in hypertension, relatively little is known of
the in vivo geometry and function of the arterial circulation in patients
with uncomplicated hypertension or of their relation to left ventricular
hypertrophy, a marker of enhanced risk of cardiovascular complications.
METHODS AND RESULTS. Wall thickness and internal diameter of the common
carotid artery and the presence of atherosclerosis within the extracranial
carotid arteries were determined by ultrasound in 43 asymptomatic
hypertensive patients and 43 normotensive subjects matched for sex, age,
and body size. Vascular stiffness was estimated from simultaneous
superimposed carotid pressure waveforms obtained with an external
solid-state transducer. Left ventricular size and function were determined
echocardiographically. Compared with normal subjects, hypertensive patients
had greater left ventricular absolute and relative wall thicknesses, left
ventricular mass, and carotid absolute and relative wall thicknesses (p
< 0.005). Carotid intimal-medial thickness exceeded the 95th percentile
of normal values in 28% of hypertensive patients (p < 0.01). Carotid
atherosclerosis was equally prevalent within the two blood pressure groups
and was associated with older age, larger left ventricular and carotid wall
thicknesses, and carotid diameter. Despite similar carotid pulse pressures,
vascular stiffness was significantly increased in the hypertensive
patients. Among the population as a whole, significant relations existed
between cardiac and vascular wall thicknesses and internal dimensions. In
multivariate analyses, these relations were statistically independent of
age and blood pressure. CONCLUSIONS. The present study documents the
presence of geometric and functional changes within the common carotid
artery in uncomplicated hypertension that parallel findings within the left
ventricle. The potential contribution of these changes to the
cardiovascular complications of hypertension, particularly in the setting
of left ventricular hypertrophy, is unknown.
ARTICLES
Parallel cardiac and vascular adaptation in hypertension
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
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