Higher systolic blood pressure was associated with a greater 4-year increase in mean carotid intima-media thickness (0.074 mm for SBP <120 mm Hg vs 0.158 mm for SBP >143 mm Hg; P<0.001).
Cohort (n=1,026)
Do elevated systolic blood pressure and pulse pressure accelerate the progression of carotid atherosclerosis in middle-aged men?
Mildly elevated systolic blood pressure and pulse pressure independently accelerate the progression of preclinical carotid atherosclerosis, highlighting SBP as a more important risk factor than DBP.
p-value: p=<0.001
Elevated blood pressure has consistently been associated with increased prevalence of preclinical atherosclerosis and with increased risk of clinical atherosclerotic cardiovascular disease (CVD). However, there is no prospective evidence of the association between blood pressure and the progression of preclinical atherosclerosis. We therefore investigated the relationships of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure to the 4-year increase in the measures of early carotid atherosclerosis, the mean and maximal common carotid intima-media thickness (IMT), assessed by B-mode ultrasonography, in 1026 men aged 42 to 60 years. Men with the SBP of 143 mm Hg (fifths) had an increase in the mean IMT of 0.074, 0.090, 0.110, 0.136, and 0.158 mm per 4 years (P<0.001 for difference between groups, P<0.001 for linear trend) and in the maximal IMT of 0.212, 0.221, 0.279, 0.286, and 0.315 mm per 4 years, (P<0.001, P<0.001), respectively, adjusting for other atherosclerotic risk factors, including DBP. Also, pulse pressure, when adjusted for other risk factors including mean arterial pressure, was directly associated with the IMT increase. DBP was not independently related to the IMT increase. This is the first documentation to show that mildly elevated SBP and pulse pressure accelerate the progression of preclinical atherosclerosis. This study provides further evidence for the finding that systolic hypertension is a more important risk factor for atherosclerosis and consequent CVD than diastolic hypertension. Therefore, more attention should be paid to the level of SBP in the evaluation of CVD risk and in the treatment of hypertension.
Lakka et al. (Thu,) conducted a cohort in Preclinical atherosclerosis (n=1,026). Systolic blood pressure, diastolic blood pressure, and pulse pressure vs. Different levels of blood pressure was evaluated on 4-year increase in the mean and maximal common carotid intima-media thickness (IMT) (p=<0.001). Higher systolic blood pressure was associated with a greater 4-year increase in mean carotid intima-media thickness (0.074 mm for SBP <120 mm Hg vs 0.158 mm for SBP >143 mm Hg; P<0.001).