Comparative characteristics of individuals with high normal blood pressure according to the carotid intima-media values

Objective. Based on factor analysis, we identified the most clinically significant characteristics of subjects with high normal blood pressure (BP) depending on the values of carotid intima-media thickness (IMT).

Design and methods. Altogether 88 patients (60 men and 28 women) with high-normal BP (Russian Society of Cardiology, 2010) were examined (mean age — 34,1±2,7 years, duration of history of high-normal BP was 4,4±1,3 years). They were divided into 2 groups: 1st included 45 individuals with IMT < 0,9 mm, the 2nd group consisted of 43 subjects with IMT ≥ 0,9 mm. All subjects underwent clinical examination, clinical and biochemical blood tests, electrocardiography (ECG), echocardiography, veloergometry, ambulatory blood pressure monitoring (ABPM) with central BP and arterial stiffness assessment, ECG monitoring, duplex scan of carotid IMT. Blood plasma levels of some hormones were also assessed.

Results. Factor analysis showed that BP is not related to other traditional risk factors in the group 1, while it is the leading factor in the 2nd group. Cardio-renal relations are present even when IMT is within normal values. Group 2 is characterized by BP-associated vascular remodeling, and left ventricular remodeling. The structural and functional changes were independent from lipid levels. Vascular stiffness correlated with changes in BP circadian rhythm. Increased IMT is associated with «non-dipper» daily BP pattern.

Conclusions. IMT increase in individuals with high normal BP may identify the risk of the transition from functional to organic vascular changes, followed by hypertension occurrence.

1. Kotovskaya JV, Trinity EA, Kobalava ZhD. Premature aging of the vascular bed: the role of arterial stiffness and the possibility of drug therapy with perindopril A. Consilium Medicum. 2013;15(10):101–107. In Russian.

2. Vasan RS, Larson MG, Leip EP, Evans JC, O’DonnellCJ, Kannel WB et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291–1297.

3. Julius S, Nesbitt SD, Egan BM, Weber MA, Michelson EL, Kaciroti N et al. Trail of Preventing Hypertension (TROPHY) Study Investigation. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med. 2006;354(16):1685–1697.

4. Sumin AN, Barbarash OL. Topical issues of the treatment of hypertension (based on the European Congress 2010). Kardiologiia. 2012; 5: 88–96. In Russian.

5. Kostyushina IS, Komarova OV, Mazo AM, Margieva TV, Dvoryakovskiy IV, Tsygin AN. Role of central hemodynamic parameters, intima-media thickness and endothelial dysfunction in children with renal arterial hypertension. Pediatricheskaya Farmakologiya = Pediatric Pharmacology. 2013;10 (3):32–37. In Russian.

6. Lande MB, Carson NL, Roy J, Meagher CC. Effects of childhood primary hypertension on carotid intima media thickness. J Hypertension. 2006;48(1):40–44.

7. Jourdan C, Wuhl E, Litwin M, Fahr K, Trelewicz J, Jobs K et al. Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens. 2005;23(9):1707–1715.

8. Urbina EM, Khoury RR, McCoy C, Daniels SR, Kimball TR, Dolan LM. Cardiac and vascular consrquences of pre-hypertension in youth. J Clin Hypertens. 2011;13(5):332–342.

9. Diagnosis and treatment of hypertension. Russian guidelines (4th revision). Moscow, 2010. Sistemniye Gipertensii = Systemic Hypertension. 2010; 3: 5–26. In Russian.

10. KhalafyanAA. Modern statistical methods for medical research. Moscow: LKI, 2008. 320 p. In Russian.

11. Dart AM, Kingwell BA. Pulse pressure — a review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001;37(4):975–984.

12. National guidelines. Chronic kidney disease: the basic principles ofscreening, diagnosis, prevention and treatment approaches. St Petersburg: “Leysha”, 2013. 19 p. In Russian.