Carotid intima-media thickness is not related with clinical outcomes in young hypertensives

Hypertension-induced subclinical vascular and cognitive changes are reversible-An observational cohort study

Beside the well-known complications of poorly controlled, long-standing hypertension, milder abnormalities induced by early-stage hypertension have also been described. In our study, the authors examined the reversibility of changes induced by early-stage hypertension. The authors performed laboratory testing, ambulatory blood pressure monitoring, carotid intima-media thickness (IMT) measurement, evaluation of stiffness parameters, assessment of various cardiac and cerebral hemodynamic parameters during head-up tilt table (HUTT) testing, and neuropsychological examinations in 49 recently diagnosed hypertensive patients. Following baseline assessment, antihypertensive therapy was commenced. After one year of therapy, lower IMT values were found. Pulse wave velocity showed a borderline significant decrease. During HUTT, several hemodynamic parameters improved. The patients performed better on neuropsychological testing and reached significantly lower scores on questionnaires evaluating anxiety. The present study shows that early vascular changes and altered cognitive function observed in newly diagnosed hypertensive patients may improve with promptly initiated antihypertensive management.

Is Carotid Artery Ultrasound Still Useful Method for Evaluation of Atherosclerosis?

Carotid ultrasound is an imaging modality that allows non-invasive assessment of vascular anatomy and function. Carotid intima-media thickness (IMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. However, in 2013, American College of Cardiology/American Heart Association guidelines designated that the carotid IMT as class III evidence level was not recommended for use in clinical practice as a routine measurement of risk assessment for a first atherosclerotic CV event. Following the announcement of this guideline, combined common carotid IMT and plaque, including plaque tissue characterization and plaque burden, using 3D ultrasound was reported to be better than either measurement alone in a variety of studies. Moreover, changes in the intima thickness were related to aging and early atherosclerosis, and remodeling of the media thickness was associated with hypertension. Separate measurement is useful for evaluating the effects of different atherosclerotic risk factors on the arterial wall; however, a more detailed and elaborate technique needs to be developed. If so, separate measurement will play an important role in the assessment of atherosclerosis and arterial wall change according to a variety of risk factors, such as metabolic syndrome. In addition, although carotid blood flow velocity is a useful tool for risk classification and prediction in clinical practice, further clinical research is needed. The value of carotid IMT by ultrasound examination for risk stratification remains controversial, and groups developing future guidelines should consider the roles of plaque presence and burden and hemodynamic parameters in additional risk stratification beyond carotid IMT in clinical practice.