Correlation analysis of structural and functional changes in the carotid artery in patients with H-type hypertension using ultrasound radiofrequency

Abstract

Objectives

To perform a correlation analysis on the structural and functional changes of the carotid artery in patients with H-type hypertension.

Methods

Outpatients and inpatients with hypertension in our hospital between 2017 and 2018 were selected and divided into the H-type hypertension group (primary hypertension + plasma homocysteine ≥ 10 umol/l) (n = 30) and the simple hypertension group (primary hypertension + plasma Hcy < 10 umol/l) (n = 30) based on the plasma homocysteine (Hcy), and 30 healthy people were included in the control group. Thickness and stiffness parameters of the intima of the carotid artery (compliance coefficient [CC], stiffness index [β], and pulse wave velocity [PWV]) were measured for all study participants using ultrasound radiofrequency signal-based quality intima-media thickness (QIMT) and quantitative arterial stiffness (QAS) for contrast analysis.

Results

Indexes such as QIMT, β, and PWV of the carotid artery were significantly higher, and the CC was significantly lower in the H-type hypertension group and simple hypertension group than the control group (p < .05), and the difference was statistically significant; these indexes were significantly higher in the H-type hypertension group than in the simple hypertension group, and the CC was significantly lower than in the control group (p < .05), and the difference was statistically significant.

Conclusions

Hypertension can accelerate structural and functional changes of the carotid artery intima, with these changes being more significant in H-type hypertension. The ultrasound radiofrequency technique can be used to quantitatively evaluate the structure and function of the carotid artery in patients with H-type hypertension.

Keywords

Carotid artery H-type hypertension quality intima-media thickness quantitative arterial stiffness ultrasound radiofrequency data

Introduction

In recent years, studies on H-type hypertension, which represents up to 75% of adult hypertension patients in China,^1,2 have shown that the elevated plasma Hcy level in hypertension patients is a risk factor for stroke.^3,4 Hypertension is generally considered a factor leading to atherosclerosis. Carotid atherosclerosis is often clinically screened at an early stage by manually measuring the intima-media thickness (IMT) of the carotid artery using ultrasonic imaging. However, errors in repeatability exist even when performed by the same operator. In this paper, we studied the correlation between structural and functional changes in the carotid artery intima in H-type hypertension by using the ultrasound radiofrequency technique.

Data and methods

Study participants

We enrolled 90 individuals aged 45–65 years, who visited our hospital between 2020 and 2021 in our study, among whom there were 30 patients with H-type hypertension, 30 patients with simple hypertension, and 30 individuals in the normal control group. Heart disease, hyperlipidemia, hyperglycemia, and smoking were excluded as potential carotid artery change-causing factors.

Instruments

The instruments used include the Esaote MyLab ClassC color Doppler ultrasonograph, LA523 probe, frequency range of 4–13 MHz, configured with QIMT and QAS analytical software.

Methods

In the rest state, the patients were placed in the horizontal recumbent position, with the head slightly tipped to the opposite side to expose the carotid artery on the detected side, and the long axis of the carotid artery was sectioned so that the anterior and posterior wall intima were plainly visible. The quality intima-media thickness (QIMT) function in the device was used to measure the IMT at 1.0–1.5 cm at the proximal end of the bifurcation of the common carotid artery posterior wall with thick intima and no plaques based on 2D visual observation, and the real-time quantitative detection value in six cardiac cycles with SD ≤ 15 were selected (Figure 1). The quantitative arterial stiffness (QAS) function in the device was used, and the common carotid artery diameters and their amplitude of variation during the six cardiac cycles were recorded automatically by the system when standard deviation (SD) ≤ 15 was selected. Parameters such as compliance coefficient (CC), stiffness index (β), and pulse wave velocity (PWV) were also acquired (Figure 2).

Figure 1.

QIMT data of the right carotid artery.

Figure 2.

QAS data of the right carotid artery.

According to the 2016 Expert Consensus on the Diagnosis and Treatment of H-type Hypertension,⁵ H-type hypertension is defined as primary hypertension with high plasma Hcy ≥ 10 umol/l.

Hypertension diagnosis was based on the 2018 Guidelines for Prevention and Treatment of Hypertension in China:⁶ patients with systolic pressure ≥ 140 mmHg (1 mmHg ≈ 0.133 kPa) or/and diastolic pressure ≥ 90 mmHg at the rest state for successive readings were diagnosed with hypertension; patients who had previously been diagnosed with hypertension, even if their blood pressure was normal, were diagnosed with hypertension; hypertension with Hcy ≥ 10 umol/l was defined as the H-type hypertension.⁷

Statistical analysis

The SPSS19.0 statistical software was used for analysis. Measurement data are expressed as mean ± standard deviation ( $\bar{x}$ ± s), and enumeration data are expressed as percentage; an independent sample t test was performed to compare two groups, and the Pearson’s correlation analysis was conducted in order to determine the relationship between two parameters. p < .05 indicated statistical significance.

Results

Comparison of general clinical data

In this study, there were no statistical differences in gender, age, blood glucose (BG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triacylglycerol (TG) levels among the H-type hypertension group, the simple hypertension group, and the control group (p > .05) (Table 1).

Table 1.

Comparison of general data between groups.

Group	Number of cases	Age	Male/female	Hcy	BG	TC	HDL-C	LDL-C	TG
H-type hypertension group	30	49.5 ± 7.8	16/14	31.12 ± 9.6	5.12 ± 1.25	4.10 ± 0.68	1.08 ± 0.29	2.74 ± 0.96	4.55 ± 0.91
Simple hypertension group	30	50.5 ± 8.6	18/12	8.38 ± 9.9	5.33 ± 1.05	4.33 ± 0.69	1.12 ± 0.31	2.69 ± 0.88	4.38 ± 0.89
Control group	30	48.9 ± 8.3	15/15	8.19 ± 10.2	4.98 ± 1.13	4.29 ± 0.66	1.02 ± 0.35	2.89 ± 0.89	4.46 ± 0.79

We compared the QIMT, CC, β, and pulse wave velocity PWV among the groups

The Pearson’s correlation analysis revealed that the Hcy level was positively correlated with the QIMT, β, and PWV of the carotid artery and negatively correlated with the CC (correlation coefficient r = −0.536, p < .001) (Figures 1 and 2) (Table 2).

Table 2.

Comparison of elastic parameters of carotid artery between groups.

Group	Number of cases	QIMT	CC	β	PWV
H-type hypertension group	30	1.32 ± 0.38	0.71 ± 0.21	14.25 ± 4.45	8.92 ± 1.75
Simple hypertension group	30	1.10 ± 0.35	0.92 ± 0.26	10.85 ± 3.95	7.81 ± 1.84
Control group	30	0.78 ± 0.29	1.12 ± 0.24	7.94 ± 1.82	6.56 ± 1.21
		p < 0.05	p < 0.001	p < 0.001	p < 0.001

Discussion

Due to the existence of speckle noise and other artifacts in ultrasonic imaging, the current ultrasonic equipment and software have made significant improvements in B-mode quality. The boundary between the common carotid intima-media structure and atherosclerotic plaque was shown to be improved, but the measurement of IMT was manually calibrated by the operator, and even when performed by the same trained operator, there was a repetition error.⁸ In clinical practice, the PWV is often used to detect the vascular status. The study of Wang et al. demonstrated good consistency of plaque tissue component information provided by virtual histology intravascular ultrasound (VH-IVUS) with pathological results.⁹ However, as an invasive examination, it is difficult to widely apply in the screening of early vascular lesions in clinic. The use of optical coherence tomography technology to observe the fine structure of coronary artery wall has certain advantages, but due to the different structures of carotid and intracranial arteries compared to coronary arteries, their application in the nervous system poses significant risks, so they are still in the exploratory stage.

In recent years, the radiofrequency signal-based QIMT and QAS techniques, which exceed the limitations of traditional ultrasound spatial resolution and produce repeatable and more accurate parameters, have become a hotspot in vascular research.¹⁰ According to a number of studies,^11–13 QIMT techniques have greater repeatability than traditional IMT measurement and can evaluate the systemic arterial elasticity morphologically and functionally in a comprehensive and objective manner, thereby enhancing the accuracy of ultrasonic measurement.

Liu et al. found in their study that compared to patients with ordinary hypertension, excessively high Hcy levels in patients may activate some inflammatory factors in the body,¹⁴ which can damage endothelial cells, mechanically stimulate hypertension, and aggravate vascular sclerosis. The results of our study also suggest that the Hcy level is positively correlated with QIMT, β, and PWV of the carotid artery, while the IMT was an early sign of arteriosclerosis. The radiofrequency signal, which can be accurate to the micron in the measurement of the diameter and IMT, has an error of only about 3% in between two successive measurements, ensuring repeatability of data.¹⁵ Numerous epidemiological investigations and tests have confirmed that the structural and functional changes of the carotid artery are closely associated with cardiovascular and cerebrovascular disease and stroke, and that carotid atherosclerosis is a risk factor for ischemic vascular disease,^16–18 wherein the risk of stroke increased by 30% when the IMT of the carotid artery increased by one SD. The ultrasound radiofrequency technique, which can be used to automatically and accurately measure early structural and functional changes in the carotid artery intima-media, and conduct analysis based on quantitative data with an accuracy at the micron level,¹⁹ is of great clinical significance for patients with no relevant clinical manifestations and positive indications at an early stage. Furthermore, its high repeatability and sensitivity also enable it to be applied to the evaluation of clinical efficacy.

Conclusion

Using ultrasound radiofrequency technique, the QIMT, CC, β, and PWV of 90 participants were measured and analyzed in this study. In comparison to the simple hypertension group and control group, the carotid artery indexes QIMT, β, and PWV were significantly higher and the CC was significantly lower in the H-type hypertension group. Based on this, it is concluded that H-type hypertension could more significantly accelerate structural and functional changes of the carotid artery intima. The ultrasound radiofrequency technique used in this study is a noninvasive detection method that involves simple operation, has high repeatability, and can be used to quantitatively evaluate the vascular structure and function. It has a high clinical application value for detecting early functional changes in blood vessels, and its possible applications in the early detection of cardiovascular and cerebrovascular diseases are extensive.

Footnotes

Author contributions

All authors have contributed significantly to the manuscript and declare that the work is original and has not been submitted or published elsewhere.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Jingmen Science and Technology Bureau General Science and Technology Project (No. 2020YFYB093).

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki. This study was conducted with approval from the Ethics Committee of The First People’s Hospital of Jingmen (No: 202002048).

Informed consent

A written informed consent was obtained from all participants.

ORCID iD

Ming Li

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