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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 84-88

Evaluation of carotid intima-media thickness in primary hypertensive patients using B-mode ultrasound: Cross- sectional study


1 Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Almadinah, Almunawarah, Saudi Arabia
2 Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Almadinah, Almunawarah, Saudi Arabia
3 Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Almadinah, Almunawarah; Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Almadinah, Almunawarah, Saudi Arabia

Date of Submission21-Mar-2020
Date of Decision16-Apr-2020
Date of Acceptance19-Apr-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Moawia Gameraddin
Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Almadinah, Almunawarah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_20_20

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  Abstract 


Background: Hypertension (HTN) is one of the most common health problems. Carotid wall changes are one of the most important and mortal complications of HTN; therefore, rapid diagnosis of HTN is essential to avoid vascular issues. Ultrasonography is a vital imaging modality used for the assessment of this vessel wall disorder by determining the carotid intima-media thickness (CIMT). The present study aims to explore the association between HTN and elevation of CIMT.
Materials and Methods: This was a cross-sectional of 81 patients with documented essential HTN and 83 healthy controls. HTN was controlled by the administration of drugs. The mean participant's age was 66.09 ± 9.94 years. The CIMT of both the right and left common carotid arteries (CCAs) was measured using the B-mode ultrasound.
Results: The CIMT in the CCAs was greater in hypertensive patients than in the controls (P < 0.001). The intima-media thickness of the right and left CCAs increased significantly as the duration of HTN increased (P = 0.023 and 0.031, respectively).
Conclusions: HTN is significantly associated with increased CIMT. The CIMT increases with increasing duration of HTN.

Keywords: Carotid, hypertension, intima-media thickness, sonography


How to cite this article:
Mustafa R, Gameraddin M, Gareeballah A. Evaluation of carotid intima-media thickness in primary hypertensive patients using B-mode ultrasound: Cross- sectional study. J Curr Res Sci Med 2020;6:84-8

How to cite this URL:
Mustafa R, Gameraddin M, Gareeballah A. Evaluation of carotid intima-media thickness in primary hypertensive patients using B-mode ultrasound: Cross- sectional study. J Curr Res Sci Med [serial online] 2020 [cited 2021 Jun 19];6:84-8. Available from: https://www.jcrsmed.org/text.asp?2020/6/2/84/304198




  Introduction Top


The carotid wall thickness is widely accepted as an important indicator of cardiovascular diseases (CVDs) such as myocardial infarction and stroke.[1] CVDs are considered the most common causes of death worldwide.[2],[3],[4] Hypertension (HTN) is one of the risk factors for increasing the carotid intima-media thickness (CIMT), and HTN is also one of the strongest risk factors for several different CVDs occurring during life.[5] If HTN is diagnosed early and well controlled, serious complications, such as heart failure, ischemic heart disease, stroke, and renal failure, can be prevented.[6] Previous studies have reported a close relationship between HTN and increased CIMT;[7] therefore, studying the CIMT is very important for avoiding CVDs.

The CIMT can be assessed by ultrasonography, a noninvasive, easy to operate, and inexpensive imaging method.[8] Ultrasonographic measurement of the CIMT is considered a safe procedure to detect the early stages of carotid atherosclerosis.[9]

Increasing awareness regarding the assessment of the CIMT is of vital importance for the prevention of CVD. The aim of this study was to explore the impact of HTN on the CIMT in Sudanese patients.


  Materials and Methods Top


This study was a cross-sectional type conducted on 81 confirmed hypertensive patients, who were compared to 83 normotensives as a control group. Both controls and cases were matched according to age and sex. This study was conducted from March 2018 to July 2018 at a Khartoum teaching hospital. Patients with diabetes mellitus, CVD, renal problems, previous vascular surgery, cerebral diseases, and smoking habits were excluded from the study.

Despite the history diagnosis of HTN in the study sample, the blood pressure (BP) was measured at the time of ultrasound examination. It was measured more than once at a relaxed status using a sphygmomanometer. In adults, BP is considered to be normal below a systolic value of 140 mmHg and under a diastolic value of 90 mmHg. High BP or HTN is considered when the systolic value exceeds 140 mmHg, and the diastolic value is over 90 mmHg at least two subsequent visits.[10]

Informed consent was obtained from the study participants, and the study was approved by the Ethics Committee of Alzaiem Alazhari University. A data collection sheet was used to document clinical history, age, and duration of HTN. BP readings were obtained before the ultrasound investigation.

The sonographic procedure

The CIMT of both the right and left common carotid arteries (CCAs) was measured using B-mode ultrasonography. An ultrasound linear probe with 7 MHZ resolution (Mindray model DP-20 portable B\W system, Shenzhen, China) was used for measuring the CIMT. Each participant was examined in a supine position, with a small pillow under the head to facilitate the visualization of the CCAs. Longitudinal and transverse planes were then obtained across the CCAs. The CIMT was measured as the distance between the two parallel echogenic lines.

Statistical analysis

The data were analyzed using the Statistical Package for the Social Sciences software for Windows, version 23 (SPSS, Inc., Chicago, IL, USA). Qualitative variables are presented as means and standard deviation and proportions. Student's t-test and analysis of variance were used for the comparison between the means of CIMT in cases and controls. Pearson's test was used to find the correlation between CIMT and the age of the participants. P < 0.05 was considered statistically significant.


  Results Top


A total of 81 participants (47 males and 34 females) aged between 43 and 85 years (mean 66.09 ± 9.94 years) were in the hypertensive group, whereas 83 participants (47 males and 36 females) aged between 41 and 86 years (mean 65.27 ± 7.84 years) were in the control group [Table 1].
Table 1: Demographic characteristics of cases and controls

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In the present study, 81 participants, who were primary HTN patients whose conditions were under control, and 83 healthy participants, who were matched with respect to sex and age, were compared regarding the CIMT. In hypertensive patients, the CIMT increased as age advanced. A significant difference was noted in the mean CIMT values (1.10 ± 0.22 mm) among the age groups of the study (P = 0.008). It was also significantly different between right and left CCAs (P = 0.016 and 0.011), respectively [Table 2]. The group aged 75–85 years revealed the most increased thickening of CIMT among the groups (mean CIMT = 1.23 ± 0.31 mm), as shown in [Table 2].
Table 2: The distribution of age groups and its relation with carotid intima-media thickness in hypertensive patients

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The mean CIMT was 1.10 ± 0.22 mm and. 62 ± 0.06 mm for hypertensive and the controls, respectively. The CIMT increased significantly more in the hypertensive group than in the controls (P < 0.001), as summarized in [Table 3].
Table 3: Comparison of carotid intima-media thickness in hypertensive patients and healthy controls

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The CIMT had a significant positive correlation with the duration of HTN; P = 0.023 and 0.031 with positive correlation coefficients = 0.25 and 0.24 for right and left CCAs, respectively [Table 4]. The mean CIMT has a positive linear correlation with a duration of HTN (r2 = 0.6568), as demonstrated in [Figure 1]. Most of the hypertensive patients were in the range of 10–14 years [Figure 2]. The sonographic measurement of carotid IMT is shown in [Figure 3].
Table 4: The correlation of the duration of hypertension with carotid intima-media thickness

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Figure 1: Scatter plot showing the linear relationship between the duration of hypertension and the mean carotid intima-media thickness

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Figure 2: Frequency distribution of the duration of hypertension in the study population

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Figure 3: A sonogram showing measurement of the carotid intima-media thickness at the left central carotid artery in a longitudinal plane

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  Discussion Top


The CIMT is an independent predictor of CVD. Several studies have reported the existence of correlations between the CIMT and HTN. In the existing literature, the risk factors of increased CIMT include age, sex, alcohol consumption, high BP, smoking, high blood sugar, high blood fat, and lifestyle habits.[11],[12],[13],[14] The current study explored the relationship between CIMT and HTN.

The present findings confirmed a statistically significant association between increased CIMT with increasing age, with a maximal value observed in the age group of 75–85 years versus the age group of 43–52 years. These observations agreed with those of previous studies.[11],[15],[16] Therefore, age is a considerable independent factor for an increase in CIMT in hypertensive patients.

The present study also revealed a significant positive correlation between the CIMT and increased duration of HTN for the right and left CCAs (P = 0.023 and 0.031, respectively). Similar findings were reported in the studies conducted by Khutan et al.[17] and Eikenda et al.[18] HTN was also shown to increase the ratio of the CIMT to the lumen of the carotid vessels.[19]

In the present study, the CIMT of the right and left CCAs were significantly higher in the hypertensive group than in the healthy participants. Previous studies found similar significantly increased CIMT values in hypertensive compared to nonhypertensive patients.[20],[21] The elevation of the CIMT might be attributed to hypertrophy of the carotid intima-media layer, which is primarily related to HTN.[22] The capacity of the arteries is a further decisive factor in determining arterial pressure. Mechanical, functional, and structural changes were reported to cause a reduction in the diameter of the carotid arteries in hypertensive patients. These changes increase systolic and pulse pressures, as well as stiffness of the arteries.[23]

In general, CIMT changes could be considered an early marker of atherosclerosis that could be detected and managed to avoid vascular damage in hypertensive cases. As HTN increased the CIMT, it should be controlled as early as possible. Sonography of the carotid vessels should also be conducted periodically.

Limitations of the study

The present study had several important limitations, including (a) unavailability of some demographic data, such as body mass index (b) a lack of related laboratory investigations, such as low-density protein, high-density lipoprotein, and cholesterol levels in the case group; and (c) an insufficient sample size. Further studies are recommended to confirm the initial findings of this study.


  Conclusions Top


The CIMT is significantly greater in hypertensive patients than in normotensives. The mean CIMT values among different age groups of hypertensives also differ significantly and are greater in older patients. The CIMT significantly increased with increasing duration of HTN.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Wu TW, Hung CL, Liu CC, Wu YJ, Wang LY, Yeh HI. Associations of cardiovascular risk factors with carotid intima-media thickness in middle-age adults and elders. J Atheroscler Thromb 2017;24:677-86.  Back to cited text no. 1
    
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McNamara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: How are pharmacists getting involved? Integr Pharm Res Pract 2019;8:1-11.  Back to cited text no. 2
    
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Heart Disease and Stroke Statistics-2019. At-a-Glance. American Heart Association; 2019. Available from: https://healthmetrics.heart.org/wp-cont ent/uploads/2019/02/At-A-Glance-Heart-Disea se-and-Stroke-Statis tics-%E2%80%93-2019.pdf. [Last accessed on 2020 Jan 20].  Back to cited text no. 3
    
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Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017;70:1-25.  Back to cited text no. 4
    
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Bhatti NK, Galougahi KK, Paz Y, Nazif T, Moses JW, Leon MB, et al. Diagnosis and management of cardiovascular disease in advanced and end-stage renal disease. J Am Heart Assoc 2016;5:e003648.  Back to cited text no. 6
    
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Baroncini LAV, Sylvestre LC, Baroncini CV, Pecoits R Filho. Assessment of carotid intima-media thickness as an early marker of vascular damage in hypertensive children. Arq Bras Cardiol 2017;108:452-7.  Back to cited text no. 7
    
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Onut R, Balanescu AP, Constantinescu D, Calmac L, Marinescu M, Dorobantu PM. Imaging atherosclerosis by carotid intima-media thickness in vivo: How to, where and in whom ? Maedica (Buchar) 2012;7:153-62.  Back to cited text no. 8
    
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Kasliwal RR, Bansal M, Desai D, Sharma M. Carotid intima-media thickness: Current evidence, practices, and Indian experience. Indian J Endocrinol Metab 2014;18:13-22.  Back to cited text no. 9
    
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Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, et al. Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Hypertension 2019;73:e35-66.  Back to cited text no. 10
    
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Qu B, Qu T. Causes of changes in carotid intima-media thickness: A literature review. Cardiovasc Ultrasound 2015;13:46.  Back to cited text no. 11
    
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Sinn DH, Kang D, Cho SJ, Chang Y, Ryu S, Song YB, et al. Weight change and development of subclinical carotid atherosclerosis among metabolically healthy adults: A cohort study. J Clin Endocrinol Metab 2020;105:dgz040.  Back to cited text no. 12
    
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Fitch KV, Looby SE, Rope A, Eneh P, Hemphill L, Lee H, et al. Effects of aging and smoking on carotid intima-media thickness in HIV-infection. AIDS 2013;27:49-57.  Back to cited text no. 13
    
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Jin Y, Kim D, Cho J, Lee I, Choi K, Kang H. Association between obesity and carotid intima-media thickness in Korean office workers: The mediating effect of physical activity. Biomed Res Int 2018;2018:4285038.  Back to cited text no. 14
    
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Nand N, Jain R, Seth S, Sen J, Sharma M. A new marker of carotid atherosclerosis in middle aged adults: Cystatin C or microalbuminuria. Indian Heart J 2010;62:320-3.  Back to cited text no. 15
    
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Juonala M, Kähönen M, Laitinen T, Hutri-Kähönen N, Jokinen E, Taittonen L, et al. Effect of age and sex on carotid intima-media thickness, elasticity and brachial endothelial function in healthy adults: The cardiovascular risk in Young Finns Study. Eur Heart J 2008;29:1198-206.  Back to cited text no. 16
    
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Khutan H, Aggarwal S, Kajal KS, Garg R, Kaur R, Kaur A. Study of carotid intimal medial thickness in essential hypertension with or without left ventricular hypertrophy. Ann Afr Med 2017;16:192-5.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Eikendal AL, Groenewegen KA, Anderson TJ, Britton AR, Engström G, Evans GW, et al. Common carotid intima-media thickness relates to cardiovascular events in adults aged & 45 years. Hypertension 2015;65:707-13.  Back to cited text no. 18
    
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Liang YL, Shiel LM, Teede H, Kotsopoulos D, McNeil J, Cameron JD, et al. Effects of blood pressure, smoking, and their interaction on carotid artery structure and function. Hypertension 2001;37:6-11.  Back to cited text no. 19
    
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Sasaki R, Yamano S, Yamamoto Y, Minami S, Yamamoto J, Nakashima T, et al. Vascular remodeling of the carotid artery in patients with untreated essential hypertension increases with age. Hypertens Res 2002;25:373-9.  Back to cited text no. 20
    
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Chironi G, Gariepy J, Denarie N, Balice M, Megnien JL, Levenson J, et al. Influence of hypertension on early carotid artery remodeling. Arterioscler Thromb Vasc Biol 2003;23:1460-4.  Back to cited text no. 21
    
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Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: A consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93-111.  Back to cited text no. 22
    
23.
Steppan J, Barodka V, Berkowitz DE, Nyhan D. Vascular stiffness and increased pulse pressure in the aging cardiovascular system. Cardiol Res Pract 2011;2011:263585.  Back to cited text no. 23
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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