The effect of cardiovascular risk factors on the carotid intima-media thickness in an old-aged cohort with hypertension: a longitudinal evolution with 4-year follow-up of a random clinical trial

Hypertension is a generally accepted atherogenic risk factor. The aim of this prospective longitudinal study was to evaluate changes in carotid intima-media thickness (c-IMT) and explore the association of cardiovascular risk factors and the carotid intima thickness in adults with hypertension using standardized methods. We used data from a subgroup of Beijing Vascular Disease Patients Evaluation Study (BEST), a population-based study of community-dwelling adults. The c-IMT, biomarkers, and carotid-femoral-pulse wave velocity (PWV) were measured at baseline, and lifestyles such as smoking status, sleeping habits, and oil or salt intake level were determined with the use of a validated questionnaire in the follow-up. We reevaluated c-IMT in all the initial 1284 (540 female and 744 male) patients with hypertension after 4 years. At reevaluation, mean (+/- SD) age was 66 +/- 1.2 years, systolic blood pressure was 138 +/- 19 mmHg, and diastolic blood pressure was 91 +/- 10 mmHg. The results showed that mean c-IMT z-scores increased significantly during 4 years (0.002 +/- 0.003, p < 0.001) as well as carotid-femoral PWV (13.99 +/- 2.74, p < 0.01) and total cholesterol (6.97 +/- 1.08, p < 0.001). Linear regression showed statistically significant associations between systolic blood pressure, diastolic blood pressure, C-reactive protein, lip-line, and heart rate with c-IMT z-scores of >1.5SD in the fully adjusted models and the p values were 0.000, 0.000, 0.017, 0.001, and 0.044, respectively . There were significant predictors for the mean effect on c-IMT z-score. In a full-model logistic regression, significant risk factors for an increase in IMT of >= 1.5 z-scores were carotid-femoral PWV (odds ratio: 1.119, confidence interval: 1.018, 1.230, p = 0.020 < 0.05) at first measurement. The conclusion of the study was that longitudinal c-IMT measurements revealed progression in subclinical atherosclerosis during a four-year period in a hypertensive old-aged cohort. Systolic or diastolic blood pressure, homocysteine, carotid-femoral PWV, and waistline were significantly related to c-IMT increment. By lifestyle and medical intervention to control these risk factors may prevent progression of c-IMT in old-aged cohort with hypertension.