From the I Clinica Medica, University of Pisa, Italy.
Correspondence to Dr Stefano Taddei, I Clinica Medica, University of Pisa, Via Roma 67, 56100 Pisa, Italy. E-mail s.taddei{at}int.med.unipi.it
Abstract—Intimal-medial thickening
of the carotid wall is considered an early marker of
atherosclerosis. Endothelial function
is impaired in the presence of various cardiovascular
risk factors that are implicated in the pathogenesis of
atherosclerosis. To evaluate the relationship between
vascular reactivity and carotid intimal-medial thickening, in 44
(mean±SD age, 45.7±8.8 years; range, 28 to 60 years; 31 men and 13
women) patients with essential hypertension who had never been treated
and whose history of increased blood pressure was no longer than 12
months, we evaluated several parameters: intimal-medial
thickening of the common carotid arteries (by B-mode ultrasound);
forearm vascular response (by strain-gauge plethysmography) to
intrabrachial infusion of acetylcholine (0.15, 0.45, 1.5, 4.5, and 15
µg/100 mL forearm tissue per minute), an
endothelium-dependent vasodilator, or sodium
nitroprusside (1, 2, and 4 µg/100 mL forearm tissue per minute), an
endothelium-independent vasodilator; calculated minimal
forearm vascular resistances (the ratio between mean
arterial pressure and maximal forearm vasodilation induced
by 13 minutes of ischemia and 1 minute of exercise); and left
ventricular mass index (on
echocardiography profile). Carotid wall
intimal-medial thickening showed a significant
(P<0.001) inverse correlation with vasodilation to
acetylcholine (r=-0.58) and age
(r=-0.40), whereas no correlation was observed with the
response to sodium nitroprusside or with minimal forearm vascular
resistances, left ventricular mass index, systolic
and diastolic blood pressures, and plasma
cholesterol and glucose levels. Moreover, vasodilation to
acetylcholine showed no correlation with minimal forearm vascular
resistances or left ventricular mass index. Although
comparison of different vascular "districts," such as the forearm
microcirculation and carotid artery, does not allow for a conclusive
interpretation, the present data indicate that in patients with
essential hypertension, carotid wall thickening is associated with
reduced endothelium-dependent vasodilation and suggest
that endothelial dysfunction might be involved in early
arterial structural alterations.
© 1998 American Heart Association, Inc.
Scientific Contributions
Endothelial Function and Common Carotid Artery Wall Thickening in Patients With Essential Hypertension
Key Words: endothelium • carotid arteries • hypertension, essential • acetylcholine • sodium nitroprusside
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