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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2007;27:2244.)
© 2007 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Carotid Intima-Media Thickness in Confirmed Prehypertensive Subjects

Predictors and Progression

Romana Femia; Michaela Kozakova; Monica Nannipieri; Clicerio Gonzales-Villalpando; Michael P. Stern; Steven M. Haffner; Ele Ferrannini

From the Department of Internal Medicine and Metabolism Unit of the C.N.R. Institute of Clinical Physiology (R.F., M.K., M.N., E.F.) and Centro de Estudios en Diabetes (C.G.-V.), American British Cowdray Hospital, Mexico City, Mexico; and the Division of Clinical Epidemiology, Department of Medicine (M.P.S., S.M.H.), University of Texas Health Science Center at San Antonio, Texas, USA.

Correspondence to Ele Ferrannini, MD, Department of Internal Medicine Via Roma, 67, 56126 Pisa, Italy. E-mail ferranni{at}ifc.cnr.it

Objective— The purpose of this study was to test whether carotid intima-media thickness (IMT) is already increased in normotensive subjects who progress to hypertension (confirmed prehypertensives) independently of known determinants of vessel wall thickness.

Methods and Results— Common carotid artery (CCA) far-wall IMT was measured (B-mode ultrasound) in 1536 subjects from the population-based Mexico City Diabetes Study at baseline and 3.5 years later. In the 136 confirmed prehypertensives, CCA-IMT (720 [253] µm, median[interquartile range]) was intermediate between normotensives (615 [140] µm) and hypertensives (725 [215] µm). After multiadjusting for gender, age, BMI, blood pressure, total cholesterol, antihypertensive therapy, and diabetes, converter status was independently associated with a higher CCA-IMT (+93±14 µm). At follow-up, CCA-IMT increased by 35 [180] µm. Gender, age, blood pressure, and presence of diabetes, but not the converter status, were significant independent predictors of CCA-IMT progression. In a model adjusting for gender, age, blood pressure (level, status and treatment), diabetes status, total and HDL-cholesterol, the G variant of the 45T/G polymorphism of the adiponectin gene was associated with a hazard ratio of 1.45 (95% CI: 1.04 to 2.01) of a baseline CCA-IMT in the top quintile.

Conclusions— In confirmed prehypertensives, CCA-IMT is increased independently of blood pressure and known determinants of wall thickness, but short-term CCA-IMT progression is not accelerated.

In 136 confirmed prehypertensives CCA far-wall IMT is increased—to values intermediate between normotensives and hypertensives—independently of known determinants of wall thickness. The 45T/G polymorphism in the adiponectin gene confers independent risk; gender, age, mean BP, diabetes, but not converter status were independent predictors of a faster CCA-IMT progression.

Key Words: blood pressure • carotid arteries • diabetes mellitus • high-resolution B-mode ultrasonography

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