Abstract 12863: Development of New Atherosclerotic Plaque in Hypertensive Patients: The Campania-Salute Network
Background: The presence of carotid atherosclerotic plaques (AP) predicts cerebrovascular events (CE) in hypertensive patients. Preventing development of carotid atherosclerosis is therefore of great importance in the management of arterial hypertension. However, some patients develop AP despite robust medical therapy and the absence of carotid atherosclerosis at initial clinical assessment. Aim of this study is to evaluate incidence and possible predictors of new AP in a large hypertensive population from an established registry.
Methods: We evaluated 1671 hypertensives (age 51±10 yrs, 57% male, systolic blood pressure (BP) 159± 21, diastolic BP 99±10 mmHg) without evidence of AP at their first clinical assessment. According to ESH/ESC guidelines, AP was defined as the evidence of focal carotid intimal-media tickness (IMT)>1.5 mm. Anthropometric and cardiovascular risk profile was analyzed prospectively.
Results: At an average follow-up period of 78±43 months, about one third of patients (34%; N=559) developed new AP. At the baseline 50% of patients were overweight, 22% obese, 45% smokers, 5.5% had diabetes and 24 % impaired fasting glucose (IFG), 59% had high cholesterol and 26% high triglycerides; metabolic syndrome (MetS) was present in 12%. Incidence of AP was associated with older age, male gender, smoking habit, higher initial and final value of systolic BP, duration of hypertension, higher number of antihypertensive meds and statins, initial uric acid, diabetes, IFG and abnormal lipid profile (all p≤0.005). In a logistic regression including initial BMI, glucose and lipid profile, MetS, hypertension information and therapy, AP was predicted by presence of initial diabetes (p=0.004; HR=2.99; CI=1.42-6.30), smoking habit (p=0.021; OR=1.51; CI=1.06-2.15), higher value of initial IMT (p≤0.0001; OR=55.15; CI=20.36-149.37), higher value of SBP (p≤0.001; OR=1.02; CI=1.00-1.04) and lowest value of DBP (p≤0.0001; OR=0.95; CI=0.93-0.98) at the end of follow-up.
Conclusion: The presence of impaired glucose metabolism, smoking habit and non-optimal systolic blood pressure control, despite higher number of antihypertensive meds, predict development of AP in treated hypertensive patients.
- © 2013 by American Heart Association, Inc.