Hypertension Status Is the Major Determinant of Carotid Atherosclerosis

Background and Purpose—Extracranial carotid artery (ECCA) atherosclerosis has been associated with hypertensionrelated 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. (Stroke. 2001;32:2265-2271.)