Aylin GÜNEŞLİ, Aynur ACIBUCA, Cihan ALTIN, Esin GEZMİŞ, Mustafa Agah TEKİNDAL, Çiğdem YALÇIN, Ozlem ALKAN

Karotis arter hasarını etkileyen kan basıncı sınırları: kesitsel bir çalışma

Amaç: Yüksek kan basıncının karotis arterler üzerinde istenmeyen etkilere yol açtığı iyi bilinmesine ragmen bu etkinin hangi değerden itibaren başladığı net değildir. Bu çalışmanın amacı bunu değerlendirmektir. Yöntem: Çalışma kesitsel planlandı ve toplam 308 birey dahil edildi. Sistolik kan basıncı (SKB) <120 mmHg ve diyastolik kan basıncı (DKB) <90 mmHg olan (optimal) bireyler 1.Gruba, SKB 120-129 mmHg ve/veya DKB 80-84 mmHg olan (normal) bireyler 2.Gruba, SKB 130-139 mmHg ve/veya DKB 85-89 mmHg olan (yüksek-normal) bireyler 3.Gruba, SKB 140-159 mmHg ve/veya DKB 90-99 mmHg olan bireyler 4.Gruba, SKB 160-179 mmHg ve/veya DKB 100-109 mmHg olan bireyler 5.Gruba ve SKB≥180 mmHg ve/veya DKB≥110 mmHg olan bireyler 6.Gruba alındı. Tüm gruplarda karotis distensibilitesi ve elastisitesi ölçülerek gruplar arasında fark olup olmadığı ve eğer fark var ise hangi kan basıncı değerinden itibaren bu farkın oluşmaya başladığı değerlendirildi. Bulgular: Tüm gruplar arasında karotis distensibilitesi ve elastisitesi yönünden istatistiksel anlamlı fark vardı (p<0.001, her iki değer için). Grup 2 ve 1 arasında anlamlı fark saptanmadı (p>0.05) ancak grup 3 ile 1 arasında anlamlı fark vardı (p<0.05). SKB>135,5 mmHg olmasının%78,2 sensitivite, %74,6 spesifite, DKB>86,5 mmHg olmasının %79,3 sensitivite ve %71,6 spesifite ile karotis distensibilitesini etkilemeye başladığı bulundu. Benzer olarak SKB>137,5 mmHg olmasının %80,4 sensitivite, %73,1 spesifite, DKB>88,5 mmHg olmasının ise %79,1 sensitivite ve %73,8spesifite ile karotis elastisitesini etkilemeye başladığı gösterildi. Sonuç: Karotis distensibilitesi ve elastisitesi kan basıncının artışı ile azalmaktadır. Yüksek-normal kan basıncına sahip bireylerde belirli bir kan basıncı değerinden sonra karotis hasarı başlıyor olabilir.

Blood pressure limits affecting carotid artery injury: a cross sectional study

Objective: Although it is well known that high blood pressure causes undesirable effects on carotid arteries, it is not clear as to which threshold value this effect starts. The aim of this study is to evaluate and determine this threshold. Materials and Methods: This cross-sectional study included a total of 308 individuals in the following groups; Group 1: individuals with systolic blood pressure (SBP) <120 mmHg and diastolic blood pressure (DBP) <80 mmHg (optimal), Group 2: SBP 120-129 mmHg and/or DBP 80-84 mmHg (normal), Group 3: SBP 130-139 mmHg and/or DBP 85-89 mmHg (high-normal), Group 4: SBP 140-159 mmHg and/or DBP 90-99 mmHg, Group 5: SBP 160-179 mmHg and/or DBP 100-109 mmHg, and Group 6: SBP≥180 mmHg and/or DBP≥110 mmHg. Carotid distensibility and elasticity were measured in all groups. Results: A statistically significant difference was determined between the groups in carotid distensibility and elasticity (p<0.001, for both values). There was no significant difference between groups 2 and 1 (p>0.05), but there was a significant difference between other groups (groups 3-4-5) and group 1 (p<0.05, for all comparisons). SBP>135.5 mmHg started to affect carotid distensibility with 78.2% sensitivity and 74.6% specificity, and DBP>86.5 mmHg with 79.3% sensitivity and 71.6% specificity. Carotid elasticity was seen to be affected by SBP>137.5 mmHg with 80.4% sensitivity and 73.1% specificity, and DBP>88.5 mmHg with 79.1% sensitivity and 73.8% specificity. Conclusion: Carotid distensibility and elasticity decreases with increasing blood pressure. In individuals with high-normal blood pressure, carotid damage may begin after a certain blood pressure value.

Keywords:

Blood pressure, Carotid artery, , Doppler,

PDF

___

1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics2019 Update: a report from the American Heart Association. Circulation. 2019;139:e528*56.
2. Vernon ST, Coffey S, Bhindi R, Soo Hoo SY, Nelson GI, Ward MR et al. Increasing proportion of ST elevation myocardial infarction patients with coronary atherosclerosis poorly explained by standard modifiable risk factors. Eur J Prev Cardiol. 2017;24:1824–30.
3. Rapsomaniki E, Timmis A, George J, PujadesRodriguez M, Shah AD, Denaxas S et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and agespecific associations in 1.25 million. people. Lancet. 2014;383:1899–911.
4. Williams B, Mancia G, Spiering W, AgabitiRosei E, Azizi M, Burnier M et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021-104.
5. Liao D, Arnett DK, Tyroler HA, Riley WA, Chambless LE, Szklo M. et al. Arterial stiffness and the development of hypertension. The ARIC study. Hypertension. 1999;34:201–6.
6. Jaroch J, Łoboz-Grudzień K, Magda S, Florescu M, Bociąga Z, Ciobanu AO et al. The relationship of carotid arterial stiffness and left ventricular concentric hypertrophy in hypertension. Adv Clin Exp Med. 2016;25:263-72.
7. Tzortzis S, Ikonomidis I, Lekakis J, Papadopoulos C, Triantafyllidi H, Parissis J et al. Incremental predictive value of carotid intima-media thickness to arterial stiffness for impaired coronary flow reserve in untreated hypertensives. Hypertens Res. 2010;33:367- 73.
8. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21:93–111.
9. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N et al. Mannheim carotid intima-media thickness and plaque consensus (2004- 2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34:290–6.
10. Marlatt KL, Kelly AS, Steinberger J, Dengel DR. The influence of gender on carotid artery compliance and distensibility in children and adults. J Clin Ultrasound. 2013;41:340–6.
11. Koivistoinen T, Virtanen M, Hutri-Kähönen N, Lehtimäki T, Jula A, Juonala M et al. Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: the Cardiovascular Risk in Young Finns Study and the Health 2000 Survey. Atherosclerosis. 2012;220:387–93.
12. Juonala M, Järvisalo MJ, Mäki-Torkko N, Kähönen M, Viikari JS, Raitakari OT. Risk factors identified in childhood and decreased carotid artery elasticity in adulthood: The Cardiovascular Risk in Young Finns Study. Circulation. 2005;112:1486–93.
13. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868–74.
14. Hurtubise J, McLellan K, Durr K, Onasanya O, Nwabuko D, Ndisang JF. The different facets of dyslipidemia and hypertension in atherosclerosis. Curr Atheroscler Rep. 2016;18:82.
15. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.
16. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.
17. Cuspidi C, Sala C, Tadic M, Gherbesi E, Grassi G, Mancia G. Pre-hypertension and subclinical carotid damage: a meta-analysis. J Hum Hypertens. 2019;33:34-40.
18. Paul TK, Chen W, Srinivasan SR, He J, Berenson GS. Contrast of the impact of multiple cardiovascular risk factors on the femoral and carotid intima-media thickness in asymptomatic young adults: the Bogalusa Heart Study. Atherosclerosis. 2011;216:359–64.
19. Natali A, Muscelli E, Casolaro A, Nilsson P, Melander O, Lalic N et al. Metabolic characteristics of prehypertension: role of classification criteria and gender. J Hypertens. 2009;27:2394–402.
20. Boesen ME, Singh D, Menon BK, Frayne R. A systematic literature review of the effect of carotid atherosclerosis on local vessel stiffness and elasticity. Atherosclerosis. 2015;243:211-22.