What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Carotid atherosclerosis with recent ischemic cerebrovascular events (n=584). Intervention: Hypertension vs. Non-hypertension. Primary outcome: Prevalence of carotid plaque lipid-rich necrotic core (LRNC) (adjusted OR 1.559, 95% CI 1.029-2.363, p=0.036).

What does this research mean for the field?

Hypertension is independently associated with greater carotid plaque burden and plaque vulnerability, particularly a higher prevalence of lipid-rich necrotic cores. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the relationship between hypertension, blood pressure control status, and carotid plaque vulnerability in symptomatic patients using magnetic resonance vessel wall imaging.

October 11, 2026BMC Cardiovascular DisordersOpen Access

Association between hypertension and carotid plaque vulnerability: a Chinese Atherosclerosis Risk Evaluation II study

Q: What are the key findings of this study?

Hypertension was independently associated with a higher prevalence of vulnerable lipid-rich necrotic cores in carotid plaques compared to non-hypertensive patients (adjusted OR 1.559).

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Key result

Hypertension linked to ~56% higher prevalence of vulnerable carotid plaque lipid-rich necrotic cores.

adjusted OR 1.559
95% CI 1.029-2.363
P=0.036
n=584

Why the study?

The associations of hypertension and blood pressure control status with carotid vulnerable plaque features in symptomatic patients were not well characterized using MR vessel wall imaging.

Does hypertension increase carotid plaque burden and vulnerability in symptomatic patients with carotid atherosclerosis?

Key Points

To evaluate the relationship between hypertension, blood pressure control status, and carotid plaque vulnerability in symptomatic patients using magnetic resonance vessel wall imaging.
Retrospective cross-sectional analysis of 584 symptomatic patients with ultrasound-detected carotid plaques from the multicenter CARE II study.
Participants were categorized into non-hypertensive (n = 148) and hypertensive (n = 436; 82 controlled, 354 uncontrolled) groups.
Carotid magnetic resonance vessel wall imaging measured vessel dimensions, normalized wall index (NWI), and plaque compositions including lipid-rich necrotic core (LRNC) and calcification (CA).
Hypertensive patients had a significantly higher prevalence of LRNC (68.58% vs. 52.03%, P < 0.001) and CA (43.80% vs. 33.78%, P = 0.032) compared to non-hypertensive patients.
After adjusting for age, sex, smoking, diabetes, hyperlipidemia, coronary heart disease, and statin therapy, hypertension remained independently associated with LRNC (adjusted OR = 1.559, 95% CI: 1.029–2.363; P = 0.036).
Plaque burden was significantly higher in hypertension, showing greater wall area (32.71 ± 11.37 mm² vs. 29.52 ± 10.80 mm², P = 0.003) and NWI (42.45% ± 9.95% vs. 40.43% ± 8.72%, P = 0.022).

Study Design

Type

Cross-Sectional (n=584)

Blinding

Single-blind (radiologists blinded to clinical data)

Multicenter

Yes

Structured PICO

Does hypertension increase carotid plaque burden and vulnerability in symptomatic patients with carotid atherosclerosis?

Population

584 adults aged 18 to 80 years with ultrasound-confirmed carotid atherosclerosis and recent cerebrovascular symptoms who underwent carotid MR vessel wall imaging.

Exposure

Hypertension (defined as SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or history of hypertension/antihypertensive medication), with subgroup analysis by blood pressure control status (well-controlled vs. poorly controlled at enrollment).

Comparator

Non-hypertensive patients (without history of hypertension and SBP < 140 mmHg and DBP < 90 mmHg).

Outcome

Carotid plaque burden (lumen area, wall area, total vessel area, maximum wall thickness, and normalized wall index), plaque composition (calcification, lipid-rich necrotic core, intraplaque hemorrhage, fibrous cap rupture), and presence of high-risk plaque, assessed via magnetic resonance (MR) vessel wall imaging.surrogate

Main Result

Odds Ratio: 1.559 (95% CI 1.029–2.363)

Absolute Event Rate: 68.58% vs 52.03%

p-value: p=0.036

Hypertension is independently associated with an increased prevalence of vulnerable carotid plaque characteristics, such as lipid-rich necrotic cores, even in patients whose blood pressure appears controlled at the time of evaluation.

Limitations

Cross-sectional design precludes causal inferences regarding the relationships between hypertension, clinical risk factors, and plaque vulnerability.
Blood pressure and antihypertensive treatment were assessed only at enrollment, reflecting current status rather than cumulative exposure.
Detailed information on the type, intensity, and duration of lipid-lowering and antihypertensive therapies was unavailable.
A substantial proportion of the original cohort was excluded because the symptomatic side could not be determined, introducing potential selection bias.
Study focused on Chinese symptomatic patients, limiting generalizability to other ethnicities or asymptomatic individuals.
Blood pressure and antihypertensive treatment were assessed only at enrollment; therefore, the controlled/uncontrolled classification reflects current blood pressure status rather than long-term blood pressure control or cumulative hypertension exposure.

Implication

Hypertension links to vulnerable carotid plaque features; leaves open whether BP control alters progression in symptomatic patients.

Abstract

To investigate the associations of hypertension and blood pressure control status with carotid vulnerable plaque features in symptomatic patients using magnetic resonance (MR) vessel wall imaging. This retrospective cross-sectional analysis used data from the multicenter Chinese Atherosclerosis Risk Evaluation II (CARE II) study. Patients with recent cerebrovascular symptoms and ultrasound-detected plaques underwent carotid MR vessel wall imaging. Participants were classified as non-hypertensive (non-HTN) or hypertensive (HTN); HTN was further divided into controlled and uncontrolled subgroups. Carotid plaque burden (lumen area, wall area, total vessel area, maximum wall thickness, and normalized wall index [NWI]), plaque composition (calcification [CA], lipid-rich necrotic core [LRNC], intraplaque hemorrhage [IPH], and fibrous cap rupture [FCR]), and high-risk plaque (HRP) were assessed. Multivariable regression adjusted for clinical confounders compared groups. A total of 584 patients were included, of whom 436 (74.66%) had hypertension. Among hypertensive patients, 82 (18.81%) had controlled hypertension and 354 (81.19%) had uncontrolled hypertension. The HTN group showed greater wall area, total vessel area, maximum wall thickness, and NWI (all P < 0.05), as well as higher prevalence of CA and LRNC (both P < 0.05). In subgroup analysis, controlled hypertension was associated with higher prevalence of CA, LRNC, IPH, and HRP (all P < 0.05). After adjustment, the difference in LRNC prevalence between HTN and non-HTN groups remained significant (adjusted OR = 1.559, 95% CI: 1.029–2.363; P = 0.036). Hypertension is associated with greater carotid plaque burden and vulnerability, especially LRNC, which remained independently associated with hypertension after adjustment for confounders; plaque characteristics also differed according to current blood pressure status.

Discussion

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Cite This Study

Jinyu et al. (2026) conducted a cross-sectional in Carotid atherosclerosis with recent ischemic cerebrovascular events (n=584). Hypertension vs. Non-hypertension was evaluated on Prevalence of carotid plaque lipid-rich necrotic core (LRNC) (adjusted OR 1.559, 95% CI 1.029-2.363, p=0.036). Hypertension was independently associated with a higher prevalence of vulnerable lipid-rich necrotic cores in carotid plaques compared to non-hypertensive patients (adjusted OR 1.559).

synapsesocial.com/papers/6acae64a082e6266f39bf4f2 https://doi.org/10.1186/s12872-026-06727-3

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Implication

Hypertension links to vulnerable carotid plaque features; leaves open whether BP control alters progression in symptomatic patients.

Association between hypertension and carotid plaque vulnerability: a Chinese Atherosclerosis Risk Evaluation II study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between hypertension and carotid plaque vulnerability: a Chinese Atherosclerosis Risk Evaluation II study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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