Duplex Carotid Scan In Hypertensive Patients At The Rivers State University Teaching Hospital Port Harcourt, Nigeria
DOI:
https://doi.org/10.60787/tnhj.v22i2.580Keywords:
Carotid, Hypertensive, cIMT, cS/D ratio, Nigerian, Stroke, cPSV, cEDVAbstract
Background: Carotid scan has proven a valuable tool in assessing atherosclerotic source of large vessel thromboembolic stroke. Duplex carotid scan is non-invasive, cheap, and readily available. This study set out to evaluate the effect of hypertension on carotid vascular parameters.
Method: Hypertensive, nondiabetic individuals attending clinics at the Rivers State University Teaching Hospital, from January 2021 to October 2021, were recruited for the study and carotid artery parameters from normal, non-hypertensive and non-diabetic individuals were compared after matching for BMI. A protocol was developed of duplex vascular parameters of the left common carotid(LCC), right common carotid artery(RCC), left internal carotid(LIC), and right internal carotid artery(RIC). Data was analyzed using Statistical Package for the Social Sciences 23.
Results: Eighty-one hypertensive who met the inclusion criteria and fifty apparently normal individuals were studied. The mean age for the hypertensive population and control was 57.26 ± 10.53yrs and 48.67 ± 7.11yrs, respectively. Mean systolic blood pressures of hypertensive population was 167.46 ± 17.73mmHgand 129 ± 11.29mmHg for controls; mean diastolic blood pressure was 88.63 ± 12.57mmHg for hypertensives and 76.04 ± 8.15 mmHg for controls. The left common carotid showed statistically significant difference in its IMT and diameter when compared with the normal population. There was a negative correlation between SBP and the PSV of the Left Internal Carotid artery.
Conclusion: Hypertension affects the structure and blood flow across the carotid vessels as shown in its impact on PSV, EDV and S/D and there is need to evaluate the role of doppler parameters as surrogates of cardiovascular markers.
Downloads
References
. Wajngarten, Mauricio, and Gisele Sampaio Silva. “Hypertension and Stroke: Update on Treatment.” European cardiology vol. 14,2 111-115. 11 Jul. 2019, doi:10.15420/ecr.2019.11.1
. Lavados PM, Hennis AJ, Fernandes JG et al. Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol. 2007; 6:362–72. doi: 10.1016/S1474-4422(07)70003-0. [PubMed] [CrossRef] [Google Scholar]
. Thrift AG, Dewey HM, Macdonell RA et al. Incidence of the major stroke subtypes: initial findings from the Northeast Melbourne stroke incidence study (NEMESIS) Stroke. 2001; 32:1732–8. doi: 10.1161/01.STR.32.8.1732. [PubMed] [CrossRef] [Google Scholar]
. Feigin V, Carter K, Hackett M et al. Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002–2003. Lancet Neurol. 2006; 5:130–9. doi: 10.1016/S1474-4422(05)70325-2. [PubMed] [CrossRef] [Google Scholar]
. Hussen A, Fentaw T. Girma S,: Comparison of Ischaemic Stroke and Haemorrhagic Stroke in Ward of Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Study, Neurologic Research International, vol 2021, Article ID 9996958, 9 pages, 2021. http:// doi.org/10.1155/2021/9996958.
. Wahab KW. The burden of stroke in Nigeria. Int J Stroke. 2008 Nov;3(4):290-2. doi: 10.1111/j.1747-4949.2008.00217. x. PMID: 18811746.
. Lorenz MW, Markus HS, Bots ML, Rosvall M and Sitzer M: Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007, 115:459–467.
. Titi M, George C, Bhattacharya D, Rahi A, Woodhead PM, Stevenson WJ, et al. Comparison of carotid Doppler ultrasound and computerised tomographic angiography in the evaluation of carotid artery stenosis. Surgeon. 2007 Jun;5(3):132-6. doi: 10.1016/s1479-666x(07)80039-4. PMID: 17575665.
. Weerakkody Y. Ultrasound assessment of carotid arterial atherosclerotic disease. Reference article, Radiopaedia.org. (accessed on 16 Feb 2022) https://doi.org/10.53347/rID-9404
. Lovett JK, Coull AJ, Rothwell PM. Early risk of recurrence by subtype of ischemic stroke in population based studies. Neurology. 2004; 62:569–573. [PubMed] [Google Scholar
. Petty GW, Brown RD, Jr, Whisnant JP, et al. Ischemic stroke subtypes: A population-based study of incidence and risk factors. Stroke. 1999; 30:2513–2516. [PubMed] [Google Scholar]
. Uchino K, Risser JMH, Smith MA, et al. Ischemic stroke subtypes among Mexican Americans and non- Hispanic whites: The BASIC project. Neurology. 2004; 63:574–576. [PubMed] [Google Scholar]
. Schneider AT, Kissela B, Woo D, et al. Ischemic stroke subtypes: A population-based study of incidence rates among blacks and whites. Stroke. 2004; 35:1552–1556. [PubMed] [Google Scholar]
. Flaherty ML, Kissela B, Khoury JC, Alwell K, Moomaw CJ, Woo D, Khatri P, Ferioli S, Adeoye O, Broderick JP, Kleindorfer D. Carotid artery stenosis as a cause of stroke. Neuroepidemiology. 2013;40(1):36-41. doi: 10.1159/000341410. Epub 2012 Oct 11. PMID: 23075828; PMCID: PMC3626492.
. Rothwell PM, Eliasziw M, Gutnikov SA, et al. for the Carotid Endarterectomy Trialists' Collaboration. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003; 361:107–116. [PubMed] [Google Scholar]
. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial.
. Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, Hennerici M, Stingele R, Fiehler J, Zeumer H, Jansen O.Lancet Neurol. 2008 Oct; 7(10):893-902.[PubMed] [Ref list]
. Stenting versus endarterectomy for treatment of carotid-artery stenosis.
. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, CREST Investigators.N Engl J Med. 2010 Jul 1; 363(1):11-23.[PubMed] [Ref list]
. Benetos A, Safar ME, Laurent S, Bouthier JD, Lagneau PL, Hugue C. Common carotid blood flow in patients with hypertension and stenosis of the internal carotid artery. J Clin Hypertens. 1986 Mar;2(1):44-54. PMID: 3522814.
. Emmanuel OS, Desalu OO, Adepoju F, Shittu A, Olasosebukun O. Prevalence of stroke in three semi urban communitities in Middle-belt region of Nigeria: a door to door survey. Pan African Medical Journal.2015;20:33[doi10.11604.Pamj.2015 20-33.4594.
. Onwuchekwa AC, Tobin-West C, Babatunde S. Prevalence and risk factors for stroke in an adult population in a rural community in the Niger Delta, south-south Nigeria. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association. 2014 Mar;23(3):505-510. DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.010. PMID: 23721622.
. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986;74(6):1399–406.
. Arboix A, Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev. 2010 Aug;6(3):150-61. doi: 10.2174/157340310791658730. PMID: 21804774; PMCID: PMC2994107.
. Brinjikji W, Nogueira RG, Kvamme P, Layton KF, Almandoz JE, Ricardo AH et al. Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology Journal of NeuroInterventional Surgery 2021;13:594-598.
. Ayoola OO,Onuwaje MA, Akintomide AO, Sonographic Assessment of the carotid intima-media thickness on B-mode ultrasonography in a Nigerian Population.Niger Med J2015;56:357- 61.
. Simon AC, O’Rourke MF, Levenson J. Arterial distensibility and its effect on wave reflection and cardiac loading in cardiovascular disease. Coron Artery Dis.1991; 2:1111-1120
. Liu Z, Ting CT, Zhu S, Yin FCP. Aortic compliance in human hypertension. Hypertension.1989; 14:129-136. [Google Scholar]
. Ricardo Armentano, Jean Louis Megnien, Alain Simon, Florence Bellenfant, Juan Barra, Jaime Levenson Effects of Hypertension on Viscoelasticity of Carotid and Femoral Arteries in Humans1 Jul 1995https://doi.org/10.1161/01.HYP.26.1.48Hypertension. 1995; 26:48–54.
. Armentano R, Simon A, Levenson J, Chau NP, Megnien JL, Pichel R. Mechanical pressure versus intrinsic effects of hypertension on large arteries in humans.
. Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC investigators. Stroke. 1993;24(9):1297–304
. Naseh G, Fard MM, Kazemi T, Mirgholami A, Hashemi N, Saburi A. Comparison of Carotid Intima-media Thickness in Hypertensive Patients and Control Group. J Cardiovasc Echogr. 2016 Apr-Jun;26(2):48-51. doi: 10.4103/2211-4122.183749. PMID: 28465960; PMCID: PMC5224654.
. Bae JH, Kim WS, Lee MS, Kim KS, Park JB, Youn HJ, et al. The changes of individual carotid artery wall layer by aging and carotid intima-media thickness value for high risk. Cardiovasc Ther. 2016;34(6):397–403
. Bots ML, Hofman A, de Bruyn AM, de Jong PT, Grobbee DE. Isolated systolic hypertension and vessel wall thickness of the carotid artery. The Rotterdam elderly study. Arterioscler Thromb. 1993;13(1):64–9
. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986 Dec; 74(6):1399-406. [PubMed] [Ref list]
. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290-6. doi: 10.1159/000343145. Epub 2012 Nov 1. PMID: 23128470; PMCID: PMC3760791.
. Shao-Yuan Chuang, Hao-Min Cheng, Gary F Mitchell, Shih-Hsien Sung, Chen-Huan Chen, Wen-Harn Pan et al, Carotid Flow Velocities and Blood Pressures Are Independently Associated With Cognitive Function, American Journal of Hypertension, Volume 32, Issue 3, March 2019, Pages 289–297, https://doi.org/10.1093/ajh/hpy165
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 The Nigerian Health Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.
