Predictors of carotid stenosis in older adults with and without isolated systolic hypertension

K Sutton-Tyrrell, H G Alcorn, S K Wolfson, S F Kelsey, L H Kuller
1993 Stroke  
and Purpose: This study was designed to determine the prevalence of carotid stenosis and atherosclerosis in older adults with and without isolated systolic hypertension and to determine risk factors for carotid artery disease in these two groups. Methods: Duplex scans were performed on 187 participants of the Systolic Hypertension in the Elderly Program and on 187 normotensive control subjects. Doppler measures of blood flow velocity were used to determine the prevalence of internal carotid
more » ... nternal carotid artery stenosis. Results: Carotid stenosis was found in 25% of hypertensive participants but in only 7% of normotensive participants (p<0.001). Among hypertensive participants, carotid stenosis was correlated with lower diastolic blood pressure (p =0.022). In multivariate analysis, systolic blood pressure of >160 mm Hg was the strongest predictor of carotid stenosis. Other variables independently related to stenosis were diastolic blood pressure of <75 mm Hg (p=0.001), alcohol use (p=0.005), heart rate of .80 beats per minute (p=0.013), smoking (p=0.034), high concentration of apoprotein B (p=0.001), and low concentration of high density lipoprotein cholesterol (borderline significant, p=0.069). Among hypertensive participants, the strongest predictor of carotid stenosis was low diastolic blood pressure. This relation persisted even after taking into account differences in pulse pressure. Conclusions: Isolated systolic hypertension is strongly correlated with carotid stenosis, and among those with isolated systolic hypertension low diastolic blood pressure is a marker for carotid stenosis. (Stroke 1993;24:355-361) KEY WORDs * carotid artery diseases * hypertension * elderly P ersons with asymptomatic carotid stenosis are at risk for stroke,1-3 but reported risk varies widely across studies and type and location of the stroke do not always implicate the diseased carotid artery. Persons with carotid stenosis are also at increased risk for ischemic heart disease,4,5 lower-extremity arterial disease,6 and death."7 This suggests that carotid stenosis marks the presence of generalized systemic atherosclerosis. The carotid arteries are easily accessible to noninvasive study using ultrasound techniques, providing researchers with the ability to measure accurately atherosclerosis and associated stenosis in its subclinical stages. By studying carotid stenosis in this manner, risk factors can be identified and patients with early disease can be targeted for treatment and risk factor modification. To this end, we have studied carotid stenosis in older adults with and without isolated systolic hypertension (ISH). This report compares the prevalence of carotid stenosis
doi:10.1161/01.str.24.3.355 pmid:8446969 fatcat:qpxgocdhw5f27ebiuvhz5cqjpm