| Objective:1. Increased carotid intima-media thickness is considered a marker of early-onset atherosclerosis. The aim of this study is to compare the difference of carotid intima-media thickness between H-type hypertensive and non-H-type hypertensive patients, and to investigate and verify the effects of H-type hypertensive on carotid intima-media thickness in patients with H-type hypertension.2. To compare the carotid plaque score, plaque location, type of plaque and combined disease situation between H-type hypertensive and non-H-type hypertensive patients. To investigate and verify the effects of Homocysteine on C-IMT and systemic arteries on the basis of the hypertension.3. We determined the risk factor of carotid intima-media thickness and understood the independent factor of carotid intima-media thickness.Methods:From January2010to December2013, the data of consecutive series of296hypertension patients (age scope:24-88years old) were collected. The blood levels of triglycerides (TG), cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and other biochemical indicators were measured.PHILIPS5500color Doppler ultrasonography was used to measure carotid intima-media thickness. Meanwhile the appearance of plaques, the location and type of plaques were determined. The plaque score is calculated, as well as the epidemiological data such as age, sex, duration, etc. were collected. The software SPSS16.0was used to establish a database. The intimal thickness, plaque score, plaque location and type were statistically analysis.The independent risk factors for C-IMT’s were determined using multiple linear regression analysis.Results:1. The comparison between aged groups showed the carotid intima-media thickness gradually increased with age. The carotid intima-media thickness showed significant differences between patients with H-type and non-H-type hypertension (t=3.724, p<0.001).2. One hundred and ninety-eight patients with H group (Hcy≥10μmo/L) and98patients with NH group (Hcy<10μmol/L) were enrolled in this study. In H group, the average age was56.01±14.47years old, and there were123men and75women. In NH group, the average age was52.74±11.72years old, and there were57men and41women. No significant difference was found in the general information of gender, age, systolic blood pressure, diastolic blood pressure, duration of hypertension, smoking history (P>0.05) and FBG, TG, TC, HDL-C, LDL-C, and other biochemical markers (P>0.05) between H group and NH group. The number of plaque (t=3.041, p=0.003) and the detection rate in H group were significantly higher than NH group (χ2=12.536; P=0.001). There was statistically significant difference in the plaque score between the two groups (t=2.532, P<0.05). Plaques were mainly distributed in the carotid artery bifurcation in the both H group and NH group (positive rate was59.6%,54.1%, respectively). There was no significant difference in the distribution of plaques between the two groups (χ2=0.817, P=0.383; χ2=1.080, P=0.311; χ2=0.919P=0.403). The detection rate of soft plaque and mixed plaque in H Group was statistically higher than NH group (χ2=4.579, P=0.040;χ2=4.230, P=0.040). The combinations of intimal thickening (χ2=7.415, P=0.010), carotid artery stenosis (χ2=5.826, P=0.020), cerebrovascular disease (χ2=17.759, P<0.001), coronary heart disease (χ2=5.199; P=0.024) in H group were significantly higher than in NH group.3. According to the carotid intima-media thickness the patients were divided into two groups:C-IMT<0.9mm group25cases combined diabetes, positive rate was13.3%;14cases combined dyslipidemia, positive rate was26.4%;1case combined cerebrovascular disease, positive rate was0.02%;6cases combined coronary heart disease, positive rate was11.3%. C-IMT>0.9mm group163cases combined diabetes, positive rate was86.7%;104cases combined dyslipidemia, positive rate was42.8%;51case combined cerebrovascular disease, positive rate was21%;65cases combined coronary heart disease, positive rate was26.7%. There was statistically difference between the two groups (χ2=7.442, χ2=4.872, χ2=13.439, χ2=5.680 P<0.05). According to the duration the patients were divided into two groups:the duration<5years group85examples, C-IMT (0.96±0.18),22cases detected patches; the duration≥5years group211examples, C-IMT (1.19±.17),133cases detected patches. The carotid intima-media thickness and number of plaque in the duration>5years group were significantly higher than the duration<5years group,(t=10.525,χ2=33.526,; P<0.01)。According to the smoking history were divided into two groups:the no smoking history group112examples,C-IMT (1.01±0.15),46cases detected patches; smoking history group184examples,C-IMT (1.19±0.20),109cases detected patches. The carotid intima-media thickness and number of plaque in the smoking history group were higher than the no smoking history group(t=8.530, χ2=9.212; P<0.05)。4. Taking the thickness of the carotid artery as the dependent variable, with associated risk factors as independent variables, through multiple linear regression analysis showed the age, gender, Hey, LDL-C, Fasting blood glucose and smoking history were the independent risk factor of the Carotid intima-media thickness.Conclusions:1. NH group of carotid intima-media thickness has more than the normal range. The thickness of carotid artery, plaque score, the number of plaques and the detection rate in H group was higher than NH group, which indicated that high homocysteine could accelerate the process of atherosclerosis on the basis of hypertensive.2. Plaques were more common in the artery bifurcation in the H Group and NH group, which should be related to the rapidly extension and blood vortex in the bifurcation. The detection rate of mixed plaques and soft plaque (plaque instability) in H Group was higher than NH group. The combination of intimal thickening, the carotid artery stenosis, cerebrovascular disease and coronary heart disease in H group was higher than NH group, which further verified the Hey was a major risk factor for atherosclerosis.3.Carotid intima-media thickness gradually increased with age. The carotid intima-media thickness is closely related with fasting blood glucose, blood lipid, cerebrovascular disease, coronary heart disease, smoking, and duration. 4. The age, male, Hcy, LDL-C, Fasting blood glucose and smoking history were the independent risk factor of the Carotid intima-media thickness. |
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