Carotid atherosclerosis in hypertension patients and its relationship with age

1. MORPHOLOGIC AND FUNCTIONAL
MODIFICATIONS OF COMMON
CAROTID ARTERIES IN
HYPERTENSION ASSOCIATED WITH
THE AGING PROCESS
AN ECHO-DOPPLER STUDY
A. Andritoiu
MILITARY HOSPITAL - CRAIOVA

2. INTRODUCTIONINTRODUCTION
Hypertensives pts are particularly prone to the develop-Hypertensives pts are particularly prone to the develop-
ment of atheromatous disease in larger vessels.ment of atheromatous disease in larger vessels.
Large arteries are not passive conduits ; they have anLarge arteries are not passive conduits ; they have an
important place in the mechanisms of hypertensive vascu-important place in the mechanisms of hypertensive vascu-
lar disease.lar disease.
The elevation of blood flow per se may be responsible forThe elevation of blood flow per se may be responsible for
mechanical and geometrical factors in development ofmechanical and geometrical factors in development of
compliance reduction.compliance reduction.
There is a significant expected relation between age andThere is a significant expected relation between age and
CCA dimensional and functional data. In HBP and agingCCA dimensional and functional data. In HBP and aging
process, structural and functional changes of arterial wallprocess, structural and functional changes of arterial wall
(remodeling) involve the totality of arterial system, princi-(remodeling) involve the totality of arterial system, princi-
pally the aorta and its major branches.pally the aorta and its major branches.
Both aging and HBP have a great impact on global levelBoth aging and HBP have a great impact on global level
of arterial stiffness.of arterial stiffness.

3. OBJECTIVESOBJECTIVES
to evaluate a few morphologic and functionalto evaluate a few morphologic and functional
parameters in a group of hypertensives ptsparameters in a group of hypertensives pts
divided into three subgroups according to thedivided into three subgroups according to the
ageage
to demonstrate the relation between HBPto demonstrate the relation between HBP
and aging process and the both contributionand aging process and the both contribution
in developing of atheromatosis process andin developing of atheromatosis process and
arterial wall stiffning of CCAarterial wall stiffning of CCA

4. METHODSMETHODS
assessment of changes in R&L- CCA wall by anassessment of changes in R&L- CCA wall by an
ultrasonographic equipmentultrasonographic equipment
( SIEMENS SONOLINE Versa Plus- 7.5 MHz linear( SIEMENS SONOLINE Versa Plus- 7.5 MHz linear
array probe)array probe)
anterior and lateral views (middle segment andanterior and lateral views (middle segment and
bifurcation)bifurcation)
morphologic parameters ( B-mode)morphologic parameters ( B-mode)
- Dd(mm), IMTh(mm), plaques evaluation- Dd(mm), IMTh(mm), plaques evaluation
functional parameters (Doppler - PW)functional parameters (Doppler - PW)
- PI, RI, S(m/s),D(m/s), S/D ratio,TAMx (m/s)- PI, RI, S(m/s),D(m/s), S/D ratio,TAMx (m/s)
intra-observer reproducibility <5%intra-observer reproducibility <5%

5. PATIENTS CHARACTERISTICSPATIENTS CHARACTERISTICS
Study group = 100 ptsStudy group = 100 pts ; BP> 160/90 mmHg; BP> 160/90 mmHg
non diabetes; smokers/non-smokers rate 1/3non diabetes; smokers/non-smokers rate 1/3
Cholesterol > 250 mg% - 22%Cholesterol > 250 mg% - 22%
GROUP I GROUP II GROUP IIIGROUP I GROUP II GROUP III
N (pts) 35 30 35N (pts) 35 30 35
age ranged 20 - 29 30 - 59 60 - 75age ranged 20 - 29 30 - 59 60 - 75
mean age(yr.) 22.4 47.5 67.8mean age(yr.) 22.4 47.5 67.8
M/F rate 30 : 5 24 : 11 21 : 9M/F rate 30 : 5 24 : 11 21 : 9
SBP(mmHg) 170+/-13 190+/-26 185+/-16SBP(mmHg) 170+/-13 190+/-26 185+/-16
DBP(mmHg) 92+/-11 114+/-14 105+/-18DBP(mmHg) 92+/-11 114+/-14 105+/-18

6. RESULTSRESULTS
I.I. MORPHOLOGICMORPHOLOGIC
PARAMETERSPARAMETERS
GROUP I GROUP II GROUP III
R-CCA L-CCA R-CCA L-CCA R-CCA L-R-CCA L-CCA R-CCA L-CCA R-CCA L-
CCACCA
Dd 5,8+/-0.8 5,6+/-0.7 6,5+/-0.7 6.7+/-0,9 8,3+/-0.3 7.7+/-0,2
(mm)
IMTh 0,45+/-0,2 0,44+/-0,2 0,67+/-0,2 0,65+/-0,3 0,89+/-0,3 0,93+/-0.2
(mm)
% Plaques 28,5% 80%
% Segnif.stenosis 22 % 14%
Mean stenosis(%) 45+/-10,7 % 38+/-9,7%

7. II . FUNCTIONAL PARAMETERSII . FUNCTIONAL PARAMETERS
GROUP I GROUP II GROUPGROUP I GROUP II GROUP
IIIIII
R-CCA L-CCA R-CCA L-CCA R-CCAR-CCA L-CCA R-CCA L-CCA R-CCA
L-CCAL-CCA
PIPI 3.16+/-1.42 2.85+/-1.38 2.04+/-0.7 1.97+/-0.6 1.08+/-0.67 1.83+/-0.623.16+/-1.42 2.85+/-1.38 2.04+/-0.7 1.97+/-0.6 1.08+/-0.67 1.83+/-0.62
RIRI 0.82+/-0.07 0.81+/-0.06 0.78+/-0.11 0.79+/-0.11 0.83+/-0.10 0.80+/-0.090.82+/-0.07 0.81+/-0.06 0.78+/-0.11 0.79+/-0.11 0.83+/-0.10 0.80+/-0.09
SS 1.02+/-0.3 1.03+/-0.3 1.05+/-0.4 0.73+/-0.2 0.86+/-0.4 0.69+/-0.21.02+/-0.3 1.03+/-0.3 1.05+/-0.4 0.73+/-0.2 0.86+/-0.4 0.69+/-0.2
DD 0.17+/-0.07 0.18+/-0.08 0.18+/-0.07 0.16+/-0.03 0.17+/-0.01 0.12+/-0.070.17+/-0.07 0.18+/-0.08 0.18+/-0.07 0.16+/-0.03 0.17+/-0.01 0.12+/-0.07
S/DS/D 6.1+/-1.6 5.7+/-1.6 4.7+/-1.7 5.2+/-1.3 3.95+/-2.7 4.79+/-2.376.1+/-1.6 5.7+/-1.6 4.7+/-1.7 5.2+/-1.3 3.95+/-2.7 4.79+/-2.37

8. LOCALIZATIONLOCALIZATION OF ATHEROSCLEROTICOF ATHEROSCLEROTIC
LESIONSLESIONS OF CAROTIDOF CAROTID ARTERIESARTERIES
GROUP II GROUP III
no of lesions >2 mm
CCA-middle 3 5
CCA-bulb 4 10
ICA 5 11
ECA 2 6
TOTAL 12 32

9. Case 1.Case 1.
Large atherosclerotic calcified plaque placed on the bulbar
segment of CCA -inferior wall

10. Case 2.Case 2.
Thickening of intima-media complex in CCA. The use of color
Doppler effect revealed well the intimal contour

11. Case 3.Case 3.
Mean eccentric CCA stenosisMean eccentric CCA stenosis due to a large fibrous plaquedue to a large fibrous plaque
A) Axial view
B) Cross-sectional view

12. CONCLUSIONSCONCLUSIONS
There was a significant expectedThere was a significant expected
relationship between age and CCArelationship between age and CCA
dimensional and functional data indicatingdimensional and functional data indicating
a widening of the lumen and walla widening of the lumen and wall
thickness with advancing age and athickness with advancing age and a
decrease in its buffering functiondecrease in its buffering function
Atherosclerosis of the CCA and carotidAtherosclerosis of the CCA and carotid
bifurcation appears like a classicalbifurcation appears like a classical
feature in subjects with E.H. particularlyfeature in subjects with E.H. particularly
in those over 60 yr. of age.in those over 60 yr. of age.

13. Large atherosclerotique plaques at theLarge atherosclerotique plaques at the
middle portion of CCA are most probably inmiddle portion of CCA are most probably in
relation with the atherosclerosis process andrelation with the atherosclerosis process and
not properly with the parietal stretch.not properly with the parietal stretch.
The decrease in CCA distensibility isThe decrease in CCA distensibility is
observed in hypertension andobserved in hypertension and
atherosclerosis and, when the two processatherosclerosis and, when the two process
are combined, both of them contribute to thisare combined, both of them contribute to this
functional disturbance.functional disturbance.