933-92 Carotid Thickening Precedes Ventricular Remodeling in Early Essential Hypertension and is Significantly Related to Early Wave Reflection

Ventricular and vascular remodeling occur early in essential hypertension, develop in parallel and may be influenced by early arterial wave reflection. To further study these relationship we examined 20 newly diagnosed, untreated mild hypertensives, 18 previously treated hypertensives and to 35 age and sex-matched normotensive normal volunteers (N), with both high frequency B-mode imaging of the carotid artery to determine carotid intima-medial thickness (IMT), diameter (CD) and relative thickness (CRWT = 2 * IMT/CD) and 2-D guided M-mode echocardiography for determination of LV posterior wall thickness (PWT), end-diastolic diameter (LVEDD), LV relative wall thickness (LVRWT = 2 * PWT/LVEDD) and LV mass index (LVMI). Using high-fidelity arterial tonometry the right carotid artery waveform was recorded and classified by measurement of augmentation index as having either a normal early systolic peak (Type C) or abnormal late systolic peak (Type A-indicating early wave reflection). Compared to N, the treated hypertensives had significantly higher LVMI (98 ± 22 vs 82 ± 22 g/m 2 , p  l 0.05) and carotid IMT (0.74 ± 0.17 vs 0.61 ± 0.15, P l 0.05). There were no significant differences in LVwall thickness, relative wall thickness or LV mass index between subjects with Type A and Type C arterial waveforms. In contrast, carotid IMT was significantly increased in patients with Type A arterial waveforms. n LVRWT LVMI CIMT (mm) CRWT MAP (mmHg) Type A (47) 0.38 ± 0.09 85 ± 25 0.69 ± 0.17 * 0.22 ± 0.04 * 105 ± 14 * Type C (22) 0.38 ± 0.10 87 ± 18 0.59 ± 0.09 0.19 ± 0.03 96 ± 14 * p l 0.01 vs. Type C In multivariate analysis, only age (p l 0.05). systolic blood pressure (p l 0.001) and augmentation index (p l 0.05) were independently associated with, CIMT. We conclude that the Type A arterial waveform indicating abnormal early wave reflection coincides with increased mean arterial pressures and with intima-medial thickening in large conduit arteries. These changes precede left ventricular remodeling and left ventricular hypertrophy in mild, essential hypertension.