Association between pulse pressure, carotid intima-media thickness and carotid and/or iliofemoral plaque in hypertensive patients.

Increased common carotid artery intima-media thickness (CCA-IMT) and carotid and/or iliofemoral (C/IF) plaque are frequent in subjects treated for hypertension, but their association with pulse pressure (PP) has rarely been studied. Using ultrasound techniques, CCA-IMT and C/IF plaques were studied in 323 hypertensive subjects, who were classified into four groups according to the adequacy of blood pressure (BP) control (systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg) and PP (high or low). After adjustment for confounding variables, an increase in CCA-IMT was the only factor significantly and independently associated with high PP, irrespective of the effectiveness of blood pressure control and of antihypertensive drug treatment. CCA-IMT correlated with age, PP, waist-to-hip ratio, tobacco consumption, and heart rate. C/IF plaques correlated with age, tobacco consumption, diabetes mellitus, and dyslipidaemia. To conclude, even with SBP<140 mmHg and DBP<90 mmHg on treatment, hypertensive subjects may have increased CCA-IMT values and C/IF plaque. Four cardiovascular risk factors seem to be involved in these alterations, namely tobacco consumption, dyslipidaemia, diabetes and increased PP. Only the latter factor does not have a standardized effective treatment.

[Primary aldosteronism. A risk factor for aortic dissection?]. / Hyperaldostéronisme primaire. Un facteur de risque de dissection aortique?

Aortic dissection is a rare but severe disease. Numerous risk factors have been reported, all leading to an alteration of arterial structures, particularly extracellular matrix. Aortic dissection is a complication of arterial hypertension, whatever its origin. Primary aldosteronism, frequent cause of secondary arterial hypertension, is associated with arterial structural alterations, indirectly by a pressure factor, and directly by aldosterone, which modifies collagen contents and elastin/collagen ratios. In addition to the three previously reported cases, the three cases reported in the present paper lead to the hypothesis of a causal relationship between aldosteronism and aortic dissection. The need for hypertension screening and diagnosis of its potential causes, namely primary aldosteronism, is highlighted.