Key result
Integrated ultrasound score stratifies hypertensive atherosclerosis risk from ~16% to 54% across score bands.
Why the study?
Although brachial artery FMD, RRI, RRICA, and carotid IMT serve as ultrasound surrogate markers of pre-clinical atherosclerosis, their interrelationship and the utility of an integrated score for indicating atherosclerotic disease in hypertensives remained under investigation.
Does an integrated ultrasound score combining FMD, RRI, RRICA, and carotid IMT stratify the prevalence of clinical and subclinical atherosclerotic disease in patients with hypertension?
Cross-Sectional (n=152)
Does an integrated ultrasound score combining FMD, RRI, RRICA, and carotid IMT stratify the prevalence of clinical and subclinical atherosclerotic disease in patients with hypertension?
An integrated, non-invasive ultrasound score combining brachial FMD, renal and retinal resistive indices, and carotid IMT effectively stratifies hypertensive patients by their burden of atherosclerotic disease.
Answers are grounded in this paper and cite their sources.
Integrated vascular score may support atherosclerosis assessment in hypertensives; leaves open its incremental predictive value in prospective cohorts.
OBJECTIVE: Flow-mediated dilatation (FMD) of brachial artery, renal resistive index (RRI), retina resistive index of central artery (RRICA) and carotid intima-media thickness (IMT) have been used for ultrasound assessment of cardiovascular risk as good surrogate markers of pre-clinical atherosclerosis. We investigated the interrelationship of these four parameters and examined whether an integrated score is a good indicator of atherosclerotic disease in hypertensives. METHODS: One-hundred fifty-two consecutive subjects were enrolled in this study between April 2004 and April 2005. Each patient underwent cerebral computed tomography, coronarography, carotid, renal, central retinal and femoral arteries Doppler ultrasonographic evaluation. Statistical analysis was performed using ANOVA, Fisher test, Pearson correlation and stepwise regression analyses. RESULTS: FMD, RRICA, IMT and RRI were significantly correlated with each other. In multiple regression analysis age, pulse pressure, hypertension duration were independently related with the four parameters. Eighty-one findings of total atherosclerotic disease (ADAD were recorded overall (15 cerebrovascular disease, 20 coronary heart disease or myocardial infarction, 22 carotid plaques and 24 low limb plaques). Using an integrated score we were able to divide the population into three scoring bands. In the lowest band we classified 87 patients with 16% of total AD; in the intermediate 40 patients with 30% of total AD, in the highest 25 patients with 54% of total AD. Differences between groups were significant (p<0.05). CONCLUSION: A potential benefit of these integrated, low-cost and easy-to-detect parameters, is the stratification of patients with atherosclerotic risk. This method may prove useful in discovering those with atherosclerosis in a pre-clinical stage for whom therapy initiated before complications could reduce the risk for a cerebro-cardio-vascular event.
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Natale et al. (2013) conducted a cross-sectional in Hypertension (n=152). Integrated ultrasound score (brachial FMD, RRI, RRICA, carotid IMT) vs. Lowest ultrasound scoring band was evaluated on Total atherosclerotic disease (composite of cerebrovascular disease, coronary heart disease/myocardial infarction, carotid plaques, and lower limb plaques) (p=<0.05). An integrated ultrasound score (FMD, RRI, RRICA, IMT) stratified total atherosclerotic disease in hypertensives from 16% in the lowest band to 30% in intermediate and 54% in the highest (p<0.05).
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