- •Preoperative hypertension is associated with more vulnerable carotid plaques.
- •These vulnerable carotid plaques contain more macrophages, lipid core and IPH.
- •Similar associations are found for diastolic BP in a iliofemoral-cohort.
- •Increased diastolic BP associates with more macrophages, lipid core and IPH.
Background and aims
Both hypertension and atherosclerotic plaque characteristics such as intraplaque hemorrhage (IPH) are associated with cardiovascular events (CVE). It is unknown if hypertension is associated with IPH. Therefore, we studied if hypertension is associated with unstable atherosclerotic plaque characteristics in patients undergoing carotid endarterectomy (CEA).
Prospectively collected data of CEA-patients (2002–2014) were retrospectively analyzed. Blood pressure (BP) was the mean of 3 preoperative measurements. Preoperative hypertension was defined as systolic BP ≥ 160 mmHg. Post-CEA, carotid atherosclerotic plaques were analyzed for the presence of calcifications, collagen, smooth muscle cells, macrophages, lipid core, IPH and microvessel density. Associations between BP (systolic and diastolic), patient characteristics and carotid plaque characteristics were assessed with univariate and multivariate analyses with correction for potential confounders. Results were replicated in a cohort of patients that underwent iliofemoral endarterectomy.
Within CEA-patients (n = 1684), 708 (42%) had preoperative hypertension. Increased systolic BP was associated with the presence of plaque calcifications (adjusted OR1.11 [95% CI 1.01–1.22], p = 0.03), macrophages (adjusted OR1.12 [1.04–1.21], p < 0.01), lipid core >10% of plaque area (adjusted OR1.15 [1.05–1.25], p < 0.01), IPH (adjusted OR1.12 [1.03–1.21], p = 0.01) and microvessels (adjusted beta 0.04 [0.00–0.08], p = 0.03). Increased diastolic BP was associated with macrophages (adjusted OR1.36 [1.17–1.58], p < 0.01), lipid core (adjusted OR1.29 [1.10–1.53], p < 0.01) and IPH (adjusted OR1.25 [1.07–1.46], p < 0.01) but not with microvessels nor plaque calcifications. Replication in an iliofemoral-cohort (n = 657) showed that increased diastolic BP was associated with the presence of macrophages (adjusted OR1.78 [1.13–2.91], p = 0.01), lipid core (adjusted OR1.45 [1.06–1.98], p = 0.02) and IPH (adjusted OR1.48 [1.14–1.93], p < 0.01).
Preoperative hypertension in severely atherosclerotic patients is associated with the presence of carotid plaque macrophages, lipid core and IPH. IPH, as a plaque marker for CVE, is associated with increased systolic and diastolic BP in both the CEA and iliofemoral population.
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Published online: September 22, 2019
Accepted: September 19, 2019
Received in revised form: July 29, 2019
Received: June 14, 2019
© 2019 Elsevier B.V. All rights reserved.