Highlights
- •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.
Abstract
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).
Methods
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.
Results
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).
Conclusions
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.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 22, 2019
Accepted:
September 19,
2019
Received in revised form:
July 29,
2019
Received:
June 14,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
