Prediction Of Pulse Pressure Combined With Carotid Intima-media Thickness For Vascular Diastolic Function In Hypertensive Patients

Objective:To investigate the relationship between vascular diastolic function and pulse pressureas well as carotid intima-media thickness in hypertensive patients. And to evaluate thepredictive value of pulse pressure combined with carotid intima-media thickness forvascular diastolic function in hypertensive patients.Methods:Five hundred and eighty-five essential hypertensive patients and one hundred andnighty-seven normotensive subjects were enrolled from the First Affiliated Hospital ofFujian Medical University between March2007and April2014. Brachial artery (BA)and anterior tibial artery (TA) were chosen as target arteries. High-resolution vascularultrasound was used to assess the rate of diameter change of the vessel after reactivehyperemia as endothelium-dependent dilatation (EDD). Endothelium-independentvasodilation (EID) was determined by the rate of diameter change of the vessel aftersublingual administration of nitroglycerin. Carotid intima-media thickness wasdetermined by ultrasound as well. Systolic blood pressure and diastolic blood pressurewere measured and pulse pressure was calculated at the same time. Hypertensivepatients were divided into different groups according to sex, age and carotidintima-media thickness. One-way ANOVA was used to compare the values betweengroups. Pearson correlation analysis was used to determine the relationship betweenvariables. Receiver Operating Characteristic Curve (ROC) was used to evaluate thepredictive value of pulse pressure combined with carotid intima-media thickness forvascular diastolic function in hypertensive patients.Results: 1. There was a mild negative correlation between pulse pressure and vasculardiastolic function. The correlation coefficient between pulse pressure andBA-EDD, TA-EDD, BA-EID, TA-EID were-0.153,-0.095,-0.151,-0.087,respectively (P<0.05). There were no correlation between pulse pressure andvascular diastolic function in normotensives.2. There was a week negative correlation between carotid intima-media thicknessand vascular diastolic function. The correlation coefficient between carotidintima-media thickness and BA-EDD, TA-EDD, BA-EID, TA-EID were-0.101,-0.150,-0.168,-0.230, respectively (P<0.05). There were no correlation betweencarotid intima-media thickness and vascular diastolic function in normotensives.3. In hypertensive patients, pulse pressure which was higher than51.00mmHg,60.50mmHg,57.50mmHg could predict a decreased BA-EDD, BA-EID andTA-EID, respectively, instead of TA-EDD. Carotid intima-media thickness whichwas more than0.1115cm,0.0865cm,0.0965cm,0.0965cm could predict adecreased BA-EDD, TA-EDD, BA-EID, TA-EID, respectively.4. In hypertensive patients, compared with pulse pressure or carotid intima-mediathickness, pulse pressure combined with carotid intima-media thickness had abetter predictive value to vascular diastolic function because of a larger areaunder ROC curve. The threshold value of pulse pressure varied in hypertensivepatients with different sex, age and carotid intima-media thickness.5. In normotensives, none of pulse pressure, carotid intima-media thickness or pulsepressure combined with carotid intima-media thickness had predictive value tovascular diastolic function.Conclusion:1. In hypertensive patients, there was negative correlation between vasculardiastolic function and pulse pressure as well as carotid intima-media thickness.2. Pulse pressure combined with carotid intima-media thickness had a predictivevalue to vascular diastolic function in hypertensive patients.