Koc Ayse Selcan, Gorgulu Ferıde Fatma, Donmez Yurdaer, Icen Yahya Kemal
Department of Radiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey.
Department of Cardiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey.
J Med Ultrason (2001). 2018 Oct;45(4):597-603. doi: 10.1007/s10396-018-0877-y. Epub 2018 Mar 13.
There are limited data about increased aortic intima-media thickness (A-IMT) in the presence of subclinical target organ damage in hypertensive (HT) patients. In this study, we aimed to determine the frequency of increased A-IMT, the parameters determining increased A-IMT, and the relationship between increased A-IMT and other vascular IMT measurements.
We prospectively included 265 patients (mean age 54.1 ± 10.6 years, male/female 91/174) with essential HT. Physical examination of all patients was performed. Laboratory data and antihypertensive treatments were recorded. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed. Bilateral carotid, brachial, and femoral artery and abdominal A-IMT values were measured by B-mode ultrasonography (USG). Patients were categorized into two main groups: patients with increased A-IMT (≥ 3 mm) or normal A-IMT (< 3 mm).
Increased A-IMT was detected in 55 patients (20.8%). There was a close relationship between increased A-IMT and advanced age, presence of coronary artery disease, high morning blood pressure surge (MBPS), and bilateral carotid and femoral IMT. Parameters associated with increased A-IMT in univariate analysis were assessed by regression analysis. Left femoral IMT and MBPS were independently associated with increased A-IMT. In the regression model, each 5-mmHg elevation in MBPS increased the risk of increased A-IMT by 34.2%. The cutoff value of MBPS obtained by the ROC curve analysis was 32 mmHg for the prediction of increased A-IMT (sensitivity 76.3%, specificity 63.5%). The area under the curve was 0.784 (95% CI 0.720-0.847, p < 0.001).
Abdominal A-IMT increased at a significant rate in patients with HT. An independent association was found between MBPS and A-IMT, which can both be easily detected by ABPM and B-mode USG. The high MBPS level was considered to be a simple and inexpensive method for detecting subclinical target organ damage. A-IMT measurement should also be a part of abdominal USG, which is a routine examination in HT patients.
关于高血压（HT）患者存在亚临床靶器官损害时主动脉内膜中层厚度（A-IMT）增加的数据有限。在本研究中，我们旨在确定A-IMT增加的频率、决定A-IMT增加的参数，以及A-IMT增加与其他血管内膜中层厚度测量值之间的关系。
我们前瞻性纳入了265例原发性HT患者（平均年龄54.1±10.6岁，男/女91/174）。对所有患者进行体格检查。记录实验室数据和降压治疗情况。进行24小时动态血压监测（ABPM）。通过B型超声检查（USG）测量双侧颈动脉、肱动脉、股动脉及腹主动脉的A-IMT值。患者被分为两个主要组：A-IMT增加（≥3mm）组或A-IMT正常（<3mm）组。
55例患者（20.8%）检测到A-IMT增加。A-IMT增加与高龄、冠状动脉疾病的存在、清晨高血压激增（MBPS）以及双侧颈动脉和股动脉内膜中层厚度密切相关。通过回归分析评估单因素分析中与A-IMT增加相关的参数。左股动脉内膜中层厚度和MBPS与A-IMT增加独立相关。在回归模型中，MBPS每升高5mmHg，A-IMT增加的风险增加34.2%。通过ROC曲线分析获得的用于预测A-IMT增加的MBPS临界值为32mmHg（敏感性76.3%，特异性63.5%）。曲线下面积为0.784（95%CI 0.720 - 0.847，p<0.001）。
HT患者腹主动脉A-IMT显著增加。发现MBPS与A-IMT之间存在独立关联，二者均可通过ABPM和B型USG轻松检测。高MBPS水平被认为是检测亚临床靶器官损害的一种简单且廉价的方法。A-IMT测量也应成为腹主动脉超声检查的一部分，而腹主动脉超声检查是HT患者的常规检查。
