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Long-term changes in carotid intima-media thickness according to baseline blood pressure level: J-STARS Echo study
Shinichi Wada1, Masatoshi Koga2, Tatsuo Kagimura3
1Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.
Insights
High baseline blood pressure (BP) in stroke patients correlates with thicker carotid intima-media thickness (IMT). This increased IMT also shows a faster progression over five years, highlighting BP
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Biology
Background:
- Investigating long-term carotid intima-media thickness (IMT) changes in non-cardioembolic stroke patients based on baseline blood pressure (BP) levels.
- Understanding the relationship between BP and vascular changes in stroke survivors is crucial for secondary prevention.
Purpose of the Study:
- To analyze the impact of baseline blood pressure (BP) on carotid intima-media thickness (IMT) progression over five years in patients who have experienced a non-cardioembolic stroke.
- To determine if specific BP thresholds are associated with accelerated IMT increase.
Main Methods:
- A randomized trial involving 792 patients (aged 45-80) with dyslipidemia and prior non-cardioembolic stroke, comparing pravastatin and control groups.
- Patients were categorized into normal BP, mildly elevated BP (G1), and highly elevated BP (G2) groups.
- Mixed-effect models analyzed annual IMT increases over 5 years, with further analysis based on specific BP cut-off levels.
Main Results:
- Baseline carotid IMT was significantly higher in both G1 and G2 groups compared to the normal BP group (P < 0.01).
- While overall IMT increase differences among the three BP groups were not significant (P = 0.091), patients with higher baseline systolic BP (≥154 mmHg) or diastolic BP (≥101 mmHg) showed a significantly greater IMT increase (P < 0.05).
Conclusions:
- Elevated baseline blood pressure is associated with increased carotid intima-media thickness in non-cardioembolic stroke patients.
- Higher baseline BP levels predict a more rapid progression of carotid IMT over a five-year period.
Background And Aims:
We aimed to investigate long-term changes in carotid intima-media thickness (IMT) based on baseline blood pressure (BP) levels in non-cardioembolic stroke patients.
Methods:
Patients aged 45-80 years with dyslipidemia who were not on statins before enrollment and had experienced a non-cardioembolic stroke were assigned to either the pravastatin group or the control group in a randomized trial. Patients were classified into three groups according to BP levels: normal BP (N-group: systolic BP [sBP] <140 mmHg and diastolic BP [dBP] <90 mmHg), highly elevated BP (G2 group: sBP ≥160 mmHg or dBP ≥100 mmHg), and mildly elevated BP (G1 group: the remaining patients). Mixed effect models were used to examine differences in slope of mean carotid IMT increases annually over the 5-year observation period among three groups, and for two groups divided based on whether they were above or below certain BP cut-off levels set at every 1 mmHg, ranging between 139 and 161 mmHg for sBP, and 89-101 mmHg for dBP.
Results:
Of 792 patients, baseline mean carotid IMT in the G1-group (0.908 ± 0.152 mm) and G2-group (0.905 ± 0.145 mm) was significantly higher than the N-group (0.870 ± 0.153 mm) (P < 0.01, for both respectively). Although there was no significant difference in the increase among three groups (P = 0.091), the increase in patients above sBP 154, 159 and 160 mmHg or dBP 101 mmHg at baseline was higher than others (P < 0.05 for all).
Conclusions:
High baseline BP correlated with a high baseline carotid IMT and its subsequent 5-year increase in non-cardioembolic stroke patients.
Clinical Trial Registration:
http://www.
Clinicaltrials:
gov.
Unique Identifier:
NCT00361530.
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Monitoring Both Arms:
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