Abstract
Pulse pressure has been recognized as a marker of cardiovascular disease in normotensives. Moreover, internal carotid artery intima-media thickness (IMT) has been proposed to reflect coronary artery lesions. The aim of the present study was to evaluate the predictive value of other parameters derived from ambulatory blood pressure monitoring (ABPM), myocardial ultrasound, and carotid ultrasound to predict the location and the severity of coronary artery disease in normotensives. One hundred and thirteen patients with suspected coronary artery disease underwent coronary angiography, 24-h ABPM and myocardial/carotid ultrasound. Multivariate analysis was applied and equations were extrapolated based on independent variables derived from ABPM and ultrasound. The Gensini score was independently correlated with male gender, pulse pressure, average heart rate for both 24-h (p=0.001) and night (p=0.006) values, as well as percentage of high systolic blood pressure (BP), average diastolic BP, average mean BP, and heart rate concerning daily mesurements (p=0.001). Moreover, the Gensini score was independently correlated with end-systolic volume, posterior wall thickness during systole and intraventricular septum thickness during diastole, along with male gender and age (p=0.001), as well as mean internal and right common carotid artery IMT (p=0.002). Similar mathematical formulas have been calculated separately for the coronary arteries and their main branches. In conclusion, the location and the severity of coronary disease can be effectively evaluated by ABPM and myocardial/carotid ultrasound in normotensives. This approach could be useful for determining atypical patients at risk and/or for treating patients with suspected coronary disease who refuse coronary angiography.
Similar content being viewed by others
Article PDF
References
Zakopoulos NA, Lekakis JP, Papamichael CM, et al: Pulse pressure in normotensives: a marker of cardiovascular disease. Am J Hypertens 2001; 14: 195–199.
Kablak-Ziembicka A, Tracz W, Przewlocki T, Pieniazek P, Sokolowski A, Konieczynska M : Association of increased carotid intima-media thickness with the extent of coronary artery disease. Heart 2004; 90: 1286–1290.
Kotsis V, Pitiriga V, Stabouli S, et al: Carotid artery intima-media thickness could predict the presence of coronary artery lesions. Am J Hypertens 2005; 18: 601–606.
Paijitprapaporn P, Jongjirasiri S, Tangpagasit L, Laothamatas J, Reungratanaamporn O, Mahanonda N : Accuracy of sixteen-slice CT scanners in detected coronary artery disease. J Med Assoc Thai 2006; 89: 72–80.
Van Mieghem CA, Cademartiri F, Mollet NR, et al: Multislice spiral computed tomography for the evaluation of stent patency after left main coronary artery stenting: a comparison with conventional coronary angiography and intravascular ultrasound. Circulation 2006; 114: 645–653.
Chobanian AV, Bakris GL, Black HR, et al: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Hypertension 2003; 42: 1206–1252.
Gensini GG : A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983; 51: 606.
Veller MG, Fisher CM, Nicolaides AN, et al: Measurement of the ultrasonic intima-media complex thickness in normal subjects. J Vasc Surg 1993; 17: 719–725.
Adams MR, Nakagoni A, Keech A, et al: Carotid intima-media thickness is only weakly correlated with the extent and severity of coronary artery disease. Circulation 1995; 92: 2127–2134.
James EM, Earnest F, Forbes GS, Reese DF, Houser OW, Folger WN : High resolution dynamic ultrasound imaging of the carotid bifurcation; a prospective evaluation. Radiology 1982; 144: 853–858.
Sahn PS, De Maria A, Kisslo J, Weyman A : The Committee om the M-mode standarization of the American Society of Echocardiography results of a survey on echocardiographic measures. Circulation 1978; 58: 1072–1083.
Devereux RB, Alonso DR, Lutas EM, et al: Echocardiographic assessment of left ventricular hypertrophy. Comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.
Messerli FH, Sungaard-Risse K, Ventura HO, Dunn FG, Glade LB, Frohlich ED : Essential hypertension in the elderly: haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamin levels. Lancet 1983; 2 ( 8357): 983–986.
Sairenchi T, Iso H, Irie F, et al: Age-specific relationship between blood pressure and the risk of total and cardiovascular mortality in Japanese men and women. Hypertens Res 2005; 28: 901–909.
Sakurai M, Miura K, Takamura T, et al: Gender differences in the association between anthropometric indices of obesity and blood pressure in Japanese. Hypertens Res 2006; 29: 75–80.
Kallikazaros I, Tsioufis C, Sideris S, Stefanadis C, Toutouzas P : Carotid artery disease as a marker for the presence of severe coronary artery disease in patients evaluated for chest pain. Stroke 1999; 30: 1002–1007.
Gradman AH, Alfayoumi F : From left ventricular hypertrophy to congestive heart failure: management of hypertensive heart disease. Prog Cardiovasc Dis 2006; 48: 326–341.
Dewey M, Teige F, Schnapauff D, et al: Noninvasive detection of coronary artery stenoses with multislice computed tomography or magnetic resonance imaging. Ann Intern Med 2006; 145: 407–415.
Craven TE, Ryu JE, Espeland MA, et al: Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis: a case control study. Circulation 1990; 82: 1230–1242.
Lekakis JP, Papamichael C, Papaioannou TG, et al: Intima-media thickness score from carotid and femoral arteries predicts the extent of coronary artery disease: intima-media thickness and CAD: Int J Cardiovasc Imaging 2005; 21: 495–501.
Jashnani KD, Kulkarni RR, Deshpande JR : Role of carotid intima-media thickness in assessment of atherosclerosis: an autopsy study. Indian Heart J 2005; 57: 319–323.
Van Popele NM, Grobbee DE, Bots ML, et al: Association between arterial stiffness and atyherosclerosis: the Rotterdam Study. Stroke 2001; 32: 454–460.
Vemmos K, Tsivgoulis G, Spengos K, et al: Pulse pressure in acute stroke as an independent predictor of long-term mortality. Crebr Dis 2004; 18: 30–36.
Eto M, Toba K, Akishita M, et al: Impact of blood pressure variability on cardiovascular events in elderly patients with hypertension. Hypertens Res 2005; 28: 1–7.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Konstandonis, D., Papadopoulos, V., Toumanidis, S. et al. Ability of Ambulatory Blood Pressure Monitoring and Myocardial/Carotid Ultrasound to Predict the Location and the Severity of Coronary Artery Lesions in Normotensive Patients: A Clinical Study. Hypertens Res 30, 741–749 (2007). https://doi.org/10.1291/hypres.30.741
Received:
Accepted:
Issue date:
DOI: https://doi.org/10.1291/hypres.30.741
Keywords
This article is cited by
-
Ambulatory Blood Pressure Monitoring in the Prediction and Prevention of Coronary Heart Disease
Current Hypertension Reports (2013)
