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KMID : 0882420080750020179
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Korean Journal of Medicine
2008 Volume.75 No. 2 p.179 ~ p.185
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Increased carotid intima-media thickness in hypertensive patients is caused by increased medial thickness
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Won Hee-Kwan
Hyun Dae-Woo
Kwon Taek-Geun
Bae Jang-Ho
Kim Wuon-Shik
Kim Ki-Young
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Abstract
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Background: It has been suggested that there is a differential response of the vasculature to systemic risk factors
for atherosclerosis. We sought to evaluate the impact of hypertension on the carotid arterial wall using new methods that
can measure each arterial wall layer.
Methods:The study subjects consisted of 163 patients who underwent carotid arterial scanning using high-resolution
ultrasound that could measure the left carotid intima-media, intima, and media separately. The individual carotid arterial
wall thickness was measured off-line by a new method using the Canny edge-detection algorithm.
Results: Hypertensive patients (n=79, mean age 61.8 years) had a higher prevalence of diabetes (31.6% vs 11.9%,
p=0.004) and a lower level of HDL-cholesterol than did normotensive patients (41.8±11.0 mg/dL vs 45.7±10.0 mg/dL,
p=0.019). Hypertensive patients had higher carotid intima-media thickness (CIMT, 0.81±0.21 mm vs 0.74±0.18 mm,
p=0.003) and carotid medial thickness (CMT, 0.46±0.12 mm vs 0.42±0.09 mm, p=0.007) than did normotensive patients,
whereas carotid intimal thickness (CIT) was not significantly different (0.34±0.04 mm vs 0.34±0.04 mm, p=0.196).
Multivariate analysis revealed that the independent factors of CIMT were CMT (β=0.915, p<0.001), hypertension (β=
0.076, p=0.008), age (β=0.074, p=0.010), and sex (β=-0.079, p=0.005). Pearson correlation coefficient between CIMT
and CMT was higher (r=0.932, p<0.001 vs r=0.445, p<0.001) than that between CIMT and CIT. The correlation between
CIMT and CMT was higher (r=0.940, p<0.001 vs r=0.910, p<0.001) in hypertensive patients than in normotensive patients,
whereas that between CIMT and CIT was lower (r=0.344, p=0.002 vs r=0.583, p<0.001) in hypertensive patients.
Conclusion: The increased CIMT is caused by increased CMT in hypertensive patients, and this finding is compatible with the medial hypertrophy seen in hypertension. The carotid medial layer should be the focus of attention in future studies looking at hypertensive patients. (Korean J Med 75:179-185, 2008)
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KEYWORD
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Hypertension, Tunica media, Carotid arteries
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