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Year : 2002  |  Volume : 12  |  Issue : 3  |  Page : 365-368
Evaluation of carotid atherosclerosis by B'mode ultrasonographic study in hypertensive patients compared with normotensive patients


C-7, Rani Seethaiachi Complex, Annamalai Nagar - 608 002, Chidambaram, Tamil Nadu, India

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   Abstract 

Objectives: To assess the carotid intima media thickness (IMT) with the help of high resolution ultra sonography and to compare the intima Media thickness of hypertensive patients with that of normotensives. Materials and methods: Two hundred and sixty patients of hypertension were studied over a period of three years and compared with seventy normotensive patients. Carotid Doppler was performed on both sides, independently by two different observers with inter observer variation being insignificant. We used WIPRO-GE Logic 400 MD scanner with 7.5 MHZ linear array superficial probe for Ultrasonography with the patient in supine position and elevation of chest by a pillow. Patient's head turned to the opposite side of examination. About 0.5 to 1.0 cm proximal to the carotid bulb, the site was chosen, intima media thickness assessed. Colour flow mapping was done and velocity and vessel size were assessed. Estimation of lipid profile was done. These values of hypertensive patients were compared with that of normotensives. Results: Normal carotid Intima media thickness is 0.77mm and 0.75mm for the Right and Left sides respectively. Intima media thickness is increased in hypertensive subjects significantly when compared with normotensives. HDL Cholesterol is significantly low and Triglycerides level is increased in hypertensive patients. Conclusion: Our study has revealed that assessment of intima media thickness of carotids as assessed by Ultrasonographic study is significantly increased in all hypertensive patients when compared with normotensives.

Keywords: B′mode Ultrasonographic study, Carotid Doppler, Atherosclerosis, Hypertension, Intima Media thickness

How to cite this article:
Adaikkappan M, Sampath R, Felix A, Sethupathy S. Evaluation of carotid atherosclerosis by B'mode ultrasonographic study in hypertensive patients compared with normotensive patients. Indian J Radiol Imaging 2002;12:365-8

How to cite this URL:
Adaikkappan M, Sampath R, Felix A, Sethupathy S. Evaluation of carotid atherosclerosis by B'mode ultrasonographic study in hypertensive patients compared with normotensive patients. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Oct 30];12:365-8. Available from: https://www.ijri.org/text.asp?2002/12/3/365/30507

   Introduction Top


By B'mode ultrasonographic study, carotid intima media thickness was assessed. Duplex Sonography combining high resolution Imaging and Doppler Spectrum analysis has proved to be a popular, non invasive, accurate, cost effective means of detecting and assessing carotid disease [1]. Doppler study is done for assessing the systolic and diastolic velocities, lumen size, along with plaque occurrence site [1],[2],[3],[4],[5],[6]. Carotid Sonography is now playing a major role in assessing the vascular pathology, replacing slowly the role and application of angiography for suspected carotid atherosclerosis. Angiography has a role in assessing the lumen size but has the drawbacks as an interventional procedure and the side effects of the contrast medium. Vessel thickness could not be assessed by it. Hence our study was carried out to assess the carotid intima media thickness by high resolution ultra sonography and to compare the intima Media thickness of hypertensive patients with that of normotensives.


   Materials and Methods Top


Patients for study comprised recently diagnosed hypertensive patients according to WHO criteria [7],[8],[9]. Two hundred and sixty patients were selected in the age group of 35-55 who were non-smokers and non-diabetics and secondary hypertension was ruled out. Seventy Normotensives were selected from the healthy volunteers (non smokers) reporting to Rajah Muthiah Medical College Hospital without diabetes mellitus and hypertension in the same age group.

We used WIPRO-GE Logic 400 MD scanner with 7.5 MHZ linear array superficial probe. The patient being in supine position and chest being elevated with a pillow and the head being turned to the opposite side of the carotid under examination. The probe was placed on the medial side of the sternocleidomastoid, to identify the carotid vessel, the carotid bulb was traced, Intima media thickness was assessed at about 0.5 to 1.0 cm proximal to the carotid bulb. The carotid wall shows two parallel echogenic lines separated by a hypoechoic region (media). The inner line is the lumen-intima interface and outer line is the media-adventitia interface. The distance between the lines is the combined thickness of the intima and media (I-M complex) [Figure - 1]. Thickness of more than 0.8 mm is suggestive of atherosclerotic disease and could be the first indication of the same. Thickening of the I-M complex or focal plaque correlates with an increased risk for development of cardiovascular symptoms in asymptomatic patients [20],[21],[22]. Colour flow mapping was done for the sample volume in all the cases. Velocity parameters, vessel size and lumen size were measured [1],[10],[11],[12],[13],[14],[15].

The same procedure was done for studying the common carotid vessel on the opposite side. Mann-Whitney U-Wilcoxson test is used to compare the two groups (Hypertensives and normotensives).


   Results Top


The systolic (154mm Hg) and diastolic (101.38mm Hg) BP values are significant when compared with normotensives (114/79mm Hg) and it correlates with I-M complex thickness. Systolic velocity (79.4 and 79) on both sides are elevated in hypertensives when compared with normotensives (58 and 56). Vessel size is also larger on both sides when compared with normotensives (hypertensives 7.9 and 7.8), (normotensives 6.8 and 6.9). The average carotid intima media thickness for normotensives is 0.74 mm and 0.72 mm for the Right and Left side respectively where as for Hypertensives it is around 1.01mm and 1.09mm respectively. Thus among our study group, patients with Hypertension showed Intima media thickness to be increased, with P value being < 0.01. [Table - 1] HDL being low (P<0.05) and TGL increased (P value < 0.05) [Table - 2] [1].


   Discussion Top


Carotid arteries are among the vessels that are prone to develop overt atherosclerotic lesions in the presence of risk factors such as cigarette smoking, Hypertension, Hyperlipidaemia and Diabetes Mellitus [8],[9]. For this reason several studies have been conducted using ultrasound assessment of Intima media thickness which is taken as a reliable surrogate measurement of intimal thickening [11].

Atherosclerotic plaques start to develop in the Carotids at approximately the same time as in the Aorta, actually preceding the Plaque occurrence in coronary arteries. It has been stated that Carotid atherosclerosis is significantly correlated with the extent of coronary atherosclerosis [1],[16],[17],[18]. Hypertension could cause atherosclerosis through a number of plausible mechanisms [7]. Briefly Hypertension has been associated with

  1. Impaired endothelium dependent arterial relaxation
  2. Enhanced monocyte and lymphocyte adherence to the endothelium and migration into intima.
  3. Enhanced macrophage accumulation in the intima
  4. Stimulated growth factors and cytokine proliferation.
  5. Stimulated smooth muscle proliferation.
  6. Increased plaque cellularity
  7. Increased susceptibility to intimal tears due to increased medial collagen synthesis and reduced arterial wall elasticity.
  8. Increased vascular oxidative stress and oxygen free radical production by arterial wall
  9. Increased Hypoxia caused by increased diffusion distances due to intimal and medial thickening


It has been noted already by earlier workers that a mild rise in blood pressure produces changes in the carotid vessel wall which can be appreciated by ultrasonography. It is noted as an index or indicator for the cardiovascular disease risk [1],[16],[17],[18]. Our study comprises patients belonging to the group of non smoking, non-diabetics with hypertension. No data is currently available for Indian population for I-M Complex thickness of common carotid Artery. These findings seem to be related to blood pressure and serum Triglyceride levels. Compared with studies done elsewhere, our study confirms that IM thickness is increased in hypertensive patients. Intima media thickness assessment could be helpful in the prediction of cardiovascular disease risk and in the management of Hypertensive patients [7],[19],[23]

 
   References Top

1.Carotid Intima and Media thickness and plaque, occurrence in Border line Hypertension. Carola Lemne, MD; Tomas Jogestrand MD, PhD: Ulf de Faire-Stroke vol 26, No 1 January 1995, Page 36-39.  Back to cited text no. 1    
2.Pignoli P. Tremoli, Poli oreste P, Paoleti R: Intimal plus medial thickness of the arterial wall a direct measurement with ultrasonic imaging. Circulation, 1986; 1399-1406.  Back to cited text no. 2    
3.Persson J, Stavenow I, Wikstrand Kisraelsson B, Fomgren J, Berglund G, Noninvasive quantification of atherosclerotic lesions: reproducibility of ultrasonographic measurement of arterial wall thickness and plaque size. Arterioscler Thromb, 1992: 12: 261.  Back to cited text no. 3    
4.Dawson DL, Strandeness De, Arterial wall thickness with high resolution B-mode imaging. In Bernstein EF, ed. Vascular Diagnosis, 4th ed, St. Louis, Mo: Mosby Co: 1993: 12: 420-431.  Back to cited text no. 4    
5.Salonen R. Salonen JT. Determinants of carotid Intima media thickness: a population based ultrasonographic study in Eastern Finnish men. J Intern med, 1991; 116: 229: 225-231, 266.  Back to cited text no. 5    
6.Lemne C, Jogestrand T, de Faire U Non invasivene assessment of vessel - wall changes in Hypertensive and normotensive controls, Clin Physiol, 1992; 12: 497-502.  Back to cited text no. 6    
7.Blood Pressure and the Progression of Carotid Atherosclerosis in Middle-Aged Men TimoA. Lakka, Riitta Salonen, George A. Kaplan, Jukka T. Salonen (Hypertension 1999; 34: 51-56.)  Back to cited text no. 7    
8.Harrisons Principles of internal medicine twelfth edition. Chapter. Atherosclerosis, Edwin - L - Bierman. 93-996. Chapter. Hypertensive vasculature disease, Gordon. H. Williams. 1001-1102.  Back to cited text no. 8    
9.John D. Wilson. Eugene braunwal, Kurt J. Isselbachel, Anthony. S. Faucci, Richard K. Root and Robert. G. Peters dorts. Editors.  Back to cited text no. 9    
10.Robbin pathologic basis of disease, Ramzi. S. Corten, Vinay Kumar, Stanley Robbins. 4th Edition. 1989. 553-558.  Back to cited text no. 10    
11.Text book of medical Imaging - Diagnostic Radiology - Grainger-Allison III rd vol IIIrd Edition, Chapter. Vascular ultra sound - Hylton B. Meire and David Cosgrove, Ronald Grainger, David Allison, Albert Baert, James Potchen - Editors. 2468-2469.  Back to cited text no. 11    
12.Factors Underlying the Increase in Carotid Initima-Media Thickness in Borderline Hypertensives P. Pauletto, P. Palatini, S. DaROs, V. Pagliara, N. Santipolo, S. Baccillieri, E. Casiglia, P. Mormino, A.C. Pessina. (Aeterioscler Thromb Vasc Biol. 1999; 19: 1231-1237).  Back to cited text no. 12    
13.Salonen JT. Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993; 87 (suppIII): II 56-II-65.  Back to cited text no. 13    
14.Lemne C. Jogestrand T. de Faire U. Carotid intima-media thickness and plaque in borderline hypertension. Stroke. 1995; 26: 34-39.  Back to cited text no. 14    
15.Howard G. Sharret R, Hesis G. Evans GW, Chambless LE, Riley WA. Burke GL. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-Mode ultrasound. ARIC Invesigatos Stroke. 1993; 24: 1297-1304.  Back to cited text no. 15    
16.Mercuri M. Devi K. Quantitative ultrasonographic evaluation of the carotid arteries in hypertension. J, Cardiovasc Risk, 1995; 2: 27-33.  Back to cited text no. 16    
17.Common carotid Intima media thickness and arterial stiffness: Indicators of Cardiovascular risk in high risk patients. The SMART study (second manifestation of arterial disease), Circulation, Simons PC; Algra A; Bots ML; Grobbee DE: Van deer Graaf Y ISSN: 0009-7322 VOL: 100 Iss: 9 Page: 951-957.  Back to cited text no. 17    
18.Mannami T. Konishi M, Baba S, Nishi N, Terao A. Prevalence of asymptomatic carotid atherosclerotic lesions detectyped by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city: the Suita study. Stroke. 1197; 28; 518-525.  Back to cited text no. 18    
19.Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and the risk of stroke and myocardial infarction: The Rotterdam Study. Circulation. 1997; 96: 1432-1437.  Back to cited text no. 19    
20.Sutton-Tyrrell K, Wolfson SK, Kuller LH. Blood pressure treatment slows the progression of carotid stenosis in patients with isolated systolic blood pressure. Stroke. 1994; 25: 44-50.  Back to cited text no. 20    
21.Polak, J.F, O'Leary D.H. Kronmar, R.A. et al Songraphic evaluation of carotid artery atherosclerosis in the elderly: Relationship of disease severity to stroke and transient ischemic attack. Radiology 1993: 188; 363 370.  Back to cited text no. 21    
22.Veller, M.G, Fischer C.M, Nicolaides, A.N. et al: Measurement of the ultrasonic Intima-media complex thickness in normal subjects.: J. vasc. Surg. 1993; 17: 719-725.  Back to cited text no. 22    
23.Intimal medial thickness of the carotid artery in south Indian diabetic and non-diabetic subjects: the Chennai Urban Population Study (CUPS), V. Mohan et al Diabetologia (2000) 43: 494-499.  Back to cited text no. 23    

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Correspondence Address:
M Adaikkappan
C-7, Rani Seethaiachi Complex, Annamalai Nagar - 608 002, Chidambaram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1]

    Tables

[Table - 1], [Table - 2]

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