Exploring carotid sonographic parameters associated with stroke risk among hypertensive stroke patients compared to hypertensive controls.

ABSTRACT

OBJECTIVES: Globally, and particularly in low- and middle-income countries, the prevalence of hypertension is increasing with a consequent rise in the burden of stroke. There is a need to identify biomarkers of stroke, which can be used to design stroke prevention programs in these populations. Sonography is an affordable and widely available imaging modality that is ideal for resource-poor countries. We conducted a case-control study to identify carotid sonographic parameters that may be associated with stroke risk among hypertensive patients. METHODS: Selected demographic, clinical, and laboratory characteristics were collected from 135 consecutive African hypertensive stroke patients and compared with 117 age and sex-matched hypertensive patients with no clinical evidence of stroke, transient ischemic attacks, or ischemic heart disease (controls). The luminal diameter, intima-media thickness, peak systolic velocity (PSV), and end-diastolic velocity (EDV) of the common and internal carotid arteries were measured in all participants, and other carotid parameters, including pulsatility and resistive indices, were derived. Univariate, bivariate, and multivariate analyses were performed RESULTS: Among hypertensive patients, carotid parameters significantly (P < .05) associated with stroke included a higher diameter and intima-media thickness as well as a lower PSV and EDV in the common carotid and proximal internal carotid arteries. However, the diameter (>6.3 mm; adjusted odds ratio [OR], 8.91; 95% confidence interval [CI], 2.18-36.34; P = .002) and EDV (>21 cm/s; adjusted OR, 0.15; 95% CI, 0.03-0.71; P = .017) of the common carotid artery were the only parameters associated with stroke in multivariate analysis. CONCLUSIONS: Among hypertensive patients, the common carotid artery diameter and EDV are significantly associated with stroke risk. These findings have implications for development and evaluation of stroke prevention programs.