What Is the Significance of Increased Carotid Intima Media Thickness in Hypertensive Adolescents?

Evaluation of endothelial function and arterial stiffness in obese individuals with insulin resistance

BACKGROUND

Obesity is associated with metabolic imbalance, including insulin resistance and endothelial dysfunction.

AIM

We aimed to evaluate clinical and vascular parameters in obese with or without insulin resistance.

METHODS

Participants ( n=39) were divided into two groups according to Homeostasis Model Assessment - Insulin Resistance lower (group 1) or higher (group 2) than 2.7. All patients were submitted to clinical, anthropometric, biochemical, vascular structure and endothelial function assessment.

RESULTS

The mean age (53±9 vs. 52±7 years, p=0.784) and body mass index (34.3±4.1 vs. 35.2±3.9 kg/m², p=0.464) were similar in both groups, and 74.4% were treated hypertensive subjects. Fasting glucose (84±7 vs. 97±18 mg/dl, p=0.004) and insulin (9.32±2.48 vs. 22.74±7.49 μU/ml, p<0.001) were higher in group 2. Group 2 presented lower HDL-cholesterol (59±14 vs. 42±12 mg/dl, p<0.001) and higher triglycerides (122±87 vs. 191±112 mg/dl, p=0.042) levels compared with group 1. HOMA-IR was correlated with abdominal circumference ( r=0.51, p=0.001), abdominal/hip ratio ( r=0.57, p<0.001) and triglycerides/HDL ratio ( r=0.53, p=0.001). Differences in brachial flow-mediated dilation did not reach statistical significance (10.2±6.2 vs. 7.9±4.7%, p=0.245). Carotid intima-media thickness, carotid-femoral pulse wave velocity (8.5±1.9 vs. 9.1±1.5 m/s, p=0.334) and central hemodynamic parameters were also similar between groups.

CONCLUSION

Obese individuals with insulin resistance have higher visceral adiposity associated with impaired glucose and lipid metabolism. Endothelial function and arterial stiffness were similar between the groups, perhaps because of antihypertensive treatment in most of these subjects.

Variation of Carotid Intima Media Thickness With Body Mass Index in Healthy Adults of Black African Descent

OBJECTIVES

Studies have shown that common carotid intima media thickness (CIMT) measured by B-mode sonography increases with body mass index (BMI) among subjects with cardiovascular diseases in different populations. However, association of body fat and subclinical atherosclerosis in the absence of these cardiovascular diseases is understudied. We aimed to evaluate the correlation between BMI and CIMT in a healthy adult population of black African ancestry.

METHODS

This is a cross-sectional prospective study in 300 consecutive apparently healthy subjects aged 18 to 70 years without history of hypertension, dyslipidemia, diabetes mellitus, and renal disease. Subjects' common carotid artery intima media thickness was measured with a 7.5-MHz linear ultrasound transducer at a point 10 mm proximal to the carotid bulb. All subjects' biodata, medical history, anthropometric (weight and height from which BMI was calculated), laboratory (fasting lipid profile and blood glucose), and CIMT values were recorded on a pro forma. Data were analysed using SPSS version 21, and significant P was set at less than .05.

RESULTS

The right, left, and average CIMT of both sides in our study subjects are 0.52 ± 0.11 mm, 0.51 ± 0.11 mm and 0.52 ± 0.11 mm respectively, with no significant difference between the right and left sides (P > .05). The right, left, and average CIMT increased with increasing age and BMI category (all P < .01) but were not significantly different between men and women (all P > .05). Age (r = .824, .825, and .827; P < .01) and BMI (r = .503, .504, .507; P < .01) had strong positive correlations with right, left, and average CIMT.

CONCLUSIONS

Increasing age and BMI category, but not sex, significantly influenced CIMT values in our apparently healthy black African population.

Assessment of Carotid Intima-Media Thickness as an Early Marker Of Vascular Damage In Hypertensive Children

Background

The increased carotid intima-media thickness (CIMT) correlates with the presence of atherosclerosis in adults and describes vascular abnormalities in both hypertensive children and adolescents.

Objective

To assess CIMT as an early marker of atherosclerosis and vascular damage in hypertensive children and adolescents compared with non-hypertensive controls and to evaluate the influence of gender, age, and body mass index (BMI) on CIMT on each group.

Methods

Observational cohort study. A total of 133 hypertensive subjects (male, n = 69; mean age, 10.5 ± 4 years) underwent carotid ultrasound exam for assessment of CIMT. One hundred and twenty-one non-hypertensive subjects (male, n = 64; mean age, 9.8 ± 4.1 years) were selected as controls for gender, age (± 1 year), and BMI (± 10%).

Results

There were no significant difference regarding gender (p = 0.954) and age (p = 0.067) between groups. Hypertensive subjects had higher BMI when compared to control group (p = 0.004), although within the established range of 10%. Subjects in the hypertensive group had higher CIMT values when compared to control group (0.46 ± 0.05 versus 0.42 ± 0.05 mm, respectively, p < 0.001; one-way ANOVA). Carotid IMT values were not significantly influenced by gender, age, and BMI when analyzed in both groups separately (Student's t-test for independent samples). According to the adjusted determination coefficient (R²) only 11.7% of CIMT variations were accounted for by group variations, including age, gender, and BMI.

Conclusions

Carotid intima-media thickness was higher in hypertensive children and adolescents when compared to the control group. The presence of hypertension increased CIMT regardless of age, gender, and BMI.

Carotid intima-media thickness and carotid plaque represent different adaptive responses to traditional cardiovascular risk factors

Aim

To assess the effects of each traditional cardiovascular risk factor (hypertension, diabetes mellitus, dyslipidemia, and smoking), including the presence of coronary artery disease (CAD), on carotid intima-media thickness (CIMT) and to assess the degree of carotid plaque occurrence.

Methods

A total of 553 outpatients (216 men and 337 women; mean age 67.06 ± 12.44 years) who underwent a carotid artery ultrasound were screened for carotid plaque and CIMT measurements.

Results

The CIMT medians were higher in males (P < .001) and in patients with hypertension (P < .001). A linear increase occurred in mean CIMT of 0.0059 mm for each year of increase in age. The presence of plaque indicated a tendency to correlate with CIMT (P = .067). The presence of hypertension associated with diabetes (P = .0061; estimated difference 0.0494 mm) or dyslipidemia (P = .0016; estimated difference 0.0472 mm) or CAD (P = .0043; estimated difference 0.0527 mm) increased the mean CIMT measurements. The probability of plaque occurrence in carotid arteries is influenced by the age (P < .001) and is higher in patients with dyslipidemia (P = .008) and CAD (P < .001).

Conclusions

Hypertension is the strongest cardiovascular risk factor that increases CIMT, followed by age and male sex. Age and dyslipidemia increase the probability of carotid plaque. Increased CIMT and plaque could be present in the same patient caused by different risk factors and with independent effects on the artery wall and different clinical prognoses.

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Hypertension alone or with diabetes, dyslipidemia or CAD increases CIMT, but not the probability of carotid plaque.

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There is no current evidence to suggest that CIMT may progress to atherosclerotic plaque.

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Increased CIMT and plaque have different clinical prognoses in the same patient.

Carotid intima media thickness as a measure of cardiovascular disease burden in nigerian africans with hypertension and diabetes mellitus

As part of a larger study of cardiovascular risk factors in nonhypertensive type 2 diabetes patients, we subjected a cohort of diabetics to B mode ultrasonography of the carotid artery to measure the intima media thickness (IMT) and compared it with values in hypertensives and apparently normal controls matched reasonably for gender and age. All groups were comparable in terms of age and gender representation. The mean (SD) of carotid IMT right and left was 0.94 mm (0.12), 0.94 mm (0.16); 0.93 mm (0.21), 0.93 mm (0.15); 0.91 mm (0.17), 0.91 mm (0.13) for diabetic, hypertensive, and normal groups, respectively. There was a nonsignificant tendency to raised IMT for the disease groups from the normal ones. Diabetic and hypertensive Nigerians are equally burdened by cardiovascular disease risk factors. Apparently normal subjects have a reasonable degree of burden suggesting the need to evaluate them for other traditional and emerging risk factors.

Pediatric hypertension update

PURPOSE OF REVIEW

The field of childhood hypertension has been changing rapidly since publication of the most recent consensus guidelines contained in the 2004 'Fourth Report'.

RECENT FINDINGS

Several epidemiologic studies have indicated that the prevalence of hypertension in children and adolescents is on the increase. A major factor behind this increase is the childhood obesity epidemic. There is substantial new information on the frequency of hypertensive target-organ damage in the young, including vascular, cardiac and renal effects. These data have led some authorities to recommend changes in how hypertension is evaluated and managed in the young.

SUMMARY

There has been significant new knowledge gained about many aspects of childhood hypertension over the past 5 years. Clinicians who care for children and adolescents with high blood pressure should familiarize themselves with these new data and incorporate them into their clinical decision-making.

Treatment of hypertension in children and adolescents

The treatment of hypertension in children and adolescents has been markedly changed in recent years by several factors, including the publication of new consensus recommendations, the obesity epidemic, and the increased availability of information on efficacy and safety of antihypertensive medications in the young. In this review we present an updated approach to the outpatient management of hypertension in the child or adolescent, utilizing representative cases to illustrate important principles as well as possible controversies.

Controversies in vascular screening art versus science

Whether or not to screen asymptomatic members of the general public for various forms of vascular disease is a controversial issue with huge medical, social, and financial ramifications. This article reviews several criteria for determining the appropriateness of vascular screening, including: (1) is it possible to detect occult vascular disease ;early'?; (2) what should we screen for, and how should we do it?; (3) who should be screened?; and (4) what standards for vascular screening should be set? While some of these controversies may ultimately be resolvable using an evidence-based approach, it is apparent that there are issues which will not be amenable to strict scientific analysis. Individualized approaches to screening will therefore remain the rule for the foreseeable future.

Ambulatory blood pressure monitoring and target organ damage in pediatrics

The prevalence of hypertension in children and adolescents is rising in association with the increasing rate of childhood obesity, and it is associated with early target organ damage. Published guidelines on high blood pressure in children and adolescents, focused on the early and accurate diagnosis of hypertension, resulted in improved ability to identify children with hypertension. Although auscultation using a mercury sphygmomanometer remains the method of choice for evaluation of hypertension in children, accumulating evidence suggests that ambulatory blood pressure monitoring is a more accurate method for diagnosis, and it is more closely associated with target organ damage. In addition, ambulatory blood pressure monitoring is a valuable tool in the assessment of white-coat hypertension, and masked hypertension in children and adolescents. Masked hypertension in children and adolescents is associated with a similar risk of target organ damage as in established hypertension.