Pulse pressure, aortic regurgitation and carotid atherosclerosis: a comparison between hypertensives and normotensives

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Abstract
SUMMARY Pulse pressure (PP) has often been associated with cardio- vascular morbidity and mortality. Patients with aortic regurgitation (AR) often have increased PP. The aim of this study is to investigate the associations among PP, AR and extracranial carotid artery (ECCA) carotid athero- sclerosis (CA) in hypertensives and age- and sex-matched normotensives. Two hundred and sixty-three hypertensive patients and 270 normotensive subjects from the Chin-Shan Community Cardiovascular Cohort participated in this study in 1996. CA, expressed as maximal common carotid artery intima-media thickness (IMT) � 75th percentile and ECCA plaque score >6, was measured using high- resolution B-mode ultrasonography. The presence of AR was assessed by echocardiography, and their relationships with CA were evaluated. Results showed measurements of CA significantly associated with increased PP. Presence of AR associated with CA, but this relationship was attenu- ated after controlling for age. Multivariate logistic regres- sion analyses revealed that an ECCA score >6 significantly increase the risk in conjunction with PP, age and smoking in hypertensives. Correspondingly, CA increased with age, smoking and left ventricular hypertrophy on electrocardio- graphy but not PP in normotensives. In conclusion, higher PP is strongly associated with CA in patients with hyper- tension. In terms of risk stratification, PP is more impor- tant in hypertensives than in normotensives which seem to imply that pulsatile haemodynamic component of BP is crucial in association with atherosclerosis.