4D.06: PROGRESSION OF CAROTID ARTERY REMODELING AND STIFFNESS IN HYPERTENSIVE PATIENTS. (June 2015) - Bruno, R.
Abstract : Objective: To evaluate the rate progression over time of carotid and aortic stiffness and carotid remodeling in hypertensive patients in real-life and explore determinants of stiffness changes over time. Design and method: In this prospective observational study, 153 hypertensive patients were evaluated at Visit 0 (V0) and after a 3.6 ± 1.2-year follow-up (V1). Carotid-femoral pulse wave velocity (PWV), carotid intima-media thickness (cIMT) and carotid stiffness (CS) were assessed. Results: Diastolic BP was reduced during follow-up, (from 142.4 ± 15.6/82.2 ± 8.8 to 141.2 ± 17.2/79.7 ± 10.9 mmHg, p = ns for systolic BP, p = 0.026 for diastolic BP), due to increased number of antihypertensive drugs (1.2 ± 1.0 to 1.8 ± 1.0, p < 0.001). PWV, cIMT, CS were unchanged from V0 to V1. Conversely a significant increase in carotid diameter was observed (from 7, 49 ± 0, 85 to 7, 80 ± 0, 81 mm, p = 0, 002). The study population was divided in tertiles according to reduction (delta V1-V0 < -0.5 m/s), stability or increase (delta V1-V0 > 0.5 m/s) in PWV or CS. Patients with reduced PWV during follow-up showed at V0 greater values of systolic BP (146.3 ± 14.4, 139.8 ± 13.6, 141.0 ± 17.4mmHg, p = 0.077), PWV (10.1 ± 2.1, 8.7 ± 1.8, 8.9 ± 1.8m/s, p < 0.05) and mean carotid diameter (7.82 ± 0.93, 7.26 ± 0.75, 7.41 ± 0.72 mm, p < 0.05) than those with stable or increased PWV. They also experienced an increased systolic BP reduction over time (-7.9 ± 17.0, -2.0 ± 15.1, +3.5 ± 18.2 mmHg, p < 0.0001) and no further carotid enlargement (+0.16 ± 0.58, +0.40 ± 0.53, +0.39 ± 0.47 mm, p = 0.046). Patients with reduced CS over time showed at V0 higher systolic BP values (146.9 ± 15.3, 144.6 ± 13.0, 135.8 ± 16.3 mmHg, p = 0, 0008) than those with stable or increased CS, a greated BP reduction over time (-10.6 ± 18.1, -4.5 ± 16.3, +7.6 ± 12.8 mmHg, p < 0.0001) and no further carotid enlargement over time (+0.13 ± 0.57, +0.35 ± 0.50, +0.45 ± 0.50 mm, p = 0, 016). Patients with increased CS over time had a lower rate of BP-lowering grug uptitration (54.7, 51.1, 31.9%, p = 0.05). Conclusions: In a cohort of hypertensive patients, followed-up for about 3 years in a real-life setting, aortic and carotid stiffness, as well as cIMT did not change over time, but there was a progression of carotid artery maladaptive remodeling. Patients with reduced PWV and CS over time showed higher BP values at baseline, greater BP reduction over time and no further carotid enlargement, possibly due to more intensive drug treatment.