Orthopaedic and plastic surgery collaboration in resolution of plantar heloma and metatarsalgia using lipofilling: a retrospective evaluation.

BACKGROUND: Plantar heloma is a keratotic disorder that can be described as a circumscribed area of thickening with a central core that may penetrate the dermis. Although often considered a minor complaint, longstanding lesions can be debilitating and severely impact on person's quality of life. We present the first retrospective case series at long-term follow-up about the use of plantar lipofilling as a treatment for metatarsalgia caused by plantar heloma. MATERIALS AND METHODS: Six patients affected by plantar heloma associated to external metatarsalgia underwent plantar lipofilling. The surgical session was performed as an outpatient procedure. Clinical evaluation was performed using the AOFAS lesser metatarsophalangeal-interphalangeal (MTP-IP) score. RESULTS: Mean AOFAS lesser MTP-IP score improved from a preoperative score of 66.6 ± 3.2 points (range 47-77 points) to a post-operative score of 92.8 ± 2.7 points (range 86-95 points); all patients were satisfied with the outcome at the final follow-up. Post-operative clinical examination at final follow-up showed an increase in thickness of the subcutaneous layer and a decrease of dermal layer thanks to the supporting and trophic action of fat cells. CONCLUSIONS: Plastic regenerative procedures applicated to a typical foot and ankle surgery field, such as metatarsal overloading, metatarsalgia and forefoot problems, should be encouraged to allow new treatment horizons.

Investigation of freshwater sponges spicules deposits in a karstic lake in Brazil.

The environmental conditions which contributed to the formation of the notorious quaternary deposits of freshwater sponge spicules in karstic lentic environments in Brazil have been subject of some speculation. No investigation has yet been conducted to test whether these deposits currently originate in karstic lakes. To provide for such an investigation, Serra Negra Lake, which is formed on an ultramafic-alkaline-carbonatite dome at central western Brazil, close to the area of occurrence of the paleo-deposits was selected for the study. Bottom sediments were sampled at 10 stations across the lake, and water was sampled at five of the stations, in June/2011 (rainy season) and October/2011 (dry season). Analysis of granulometry, organic matter and presence of spicules were carried out in the sediments. Lake water was analysed for the main physical and chemical characteristics. Deposit of spicules was restricted to the northern area of the lake, which is rich in macrophyte. The taxonomic analysis of the spicules indicated the contribution of five sponge species, Dosilia pydanieli, Metania spinata, Radiospongilla amazonensis, Trochospongilla variabilis and Heterorotula fistula, which formed large deposits in neighbouring areas. The high silica concentration, derived from the dome volcanic rocks, constant water level and available substrate are credited for the continuous production of sponges and spicules, confirmed by the rare presence of gemmoscleres. The lake is classed as a minerotrophic fen type of bog with a heavy contribution from the surrounding creeks. Lake sediments are fine with high levels of organic matter and peat, which contributed to the trapping of spicules in the sediments.

Clinic-daytime blood pressure difference and cardiovascular damage.

OBJECTIVE: To investigate whether the clinic-daytime blood pressure difference can provide information on vascular reactivity to stress comparable to that of simple noninvasive stimuli such as a cold pressor test and isometric exercise, and whether there is any relationship between this blood pressure difference and noninvasive measurements of the left ventricular mass and carotid arterial wall. DESIGN: Patients with newly discovered, never-treated, sustained hypertension were included in the study after a 1 month run-in, during which time their blood pressure was measured three times at 2 week intervals. METHODS: Blood pressure was measured by a noninvasive procedure at rest and during a cold pressor test and an isometric exercise. The difference was calculated for systolic, diastolic and mean blood pressure as resting minus daytime ambulatory blood pressure. Parameters of the posterior wall and septal thickness of the left ventricle, aortic root and left atrium were studied by M-mode echocardiography. Carotid wall thickness and diameter were measured using ultrasound. RESULTS: The 90 patients enrolled in the study were divided into tertiles of clinic-daytime blood pressure difference. The composition of the groups differed in sex, since the majority of women were in the highest tertile, but was comparable for age, body mass index, renin-aldosterone axis and lipid and carbohydrate metabolism. Blood pressure responses to cold and isometric exercise were more pronounced in patients in the lowest tertile of blood pressure difference. No intergroup differences were detected in echocardiographic parameters of ventricular (left ventricular mass, tertiles I-III: 46.5 +/- 10, 42.3 +/- 8, 44.8 +/- 13 g/m2.7, respectively) and carotid (intima-media thickness, tertiles I-III 0.58 +/- 0.1, 0.54 +/- 0.1, 0.62 +/- 0.1 mm, respectively) structure. CONCLUSIONS: The present study indicates that the clinic-daytime blood pressure difference provides different information on cardiovascular reactivity compared with that obtained from the cold pressor test and isometric exercise. Moreover, it does not seem to have any relationship with ventricular hypertrophy and/or carotid wall thickening.

Isolated office hypertension and end-organ damage.

BACKGROUND: Patients with elevated blood pressure levels in the doctor's office but normal blood pressures at other times have recently been described as having 'isolated office hypertension' (IOH). There is debate concerning whether this condition is really benign and thus not in need of treatment. Most of the previous studies on this topic included patients who had already been administered antihypertensive treatment, which unavoidably alters their cardiovascular profile. OBJECTIVE: To evaluate whether recently discovered and never-treated patients with isolated office hypertension have structural or functional abnormalities in comparison with normotensive controls. METHODS: Patients included in the study underwent 24 h ambulatory blood pressure monitoring, M-mode echocardiography and high-resolution echography of carotid arteries. Parameters of lipid and carbohydrate metabolism were also determined. RESULTS: We investigated 76 patients (20 with IOH and 56 with sustained hypertension) who had recently been diagnosed hypertensive but never been administered antihypertensive treatment and 32 matched controls. No changes were detected in left ventricular mass (LVM h2.7, 41.5 +/- 11, 44.5 +/- 10 and 41.5 +/- 10 g/cm2.7 in IOH, sustained hypertension and controls, respectively) and in intimal-medial thickness (IMT, 0.54 +/- 0.13, 0.59 +/- 0.14 and 0.55 +/- 0.16 mm, respectively). However, the left ventricular diastolic function was significantly different (E/A = 1.08 +/- 0.3, 1.04 +/- 0.3 and 1.43 +/- 0.3, respectively, P = 0.02) and the carotid diameter significantly lower than that expected from the pressure-diameter relationship for normotensives. CONCLUSIONS: These results, at variance with those of others, suggest that IOH affects the cardiovascular system even during the early phases of the disease and indicate the need for prospective clinical trials to evaluate the benefit from early treatment of IOH patients.

Cardiovascular abnormalities in never-treated hypertensives according to nondipper status.

Ambulatory blood pressure monitoring allows a better understanding of blood pressure fluctuations over 24 h than simple clinic measurements. In this way the diagnosis of "white coat" versus "sustained" hypertension and that of "dipper" (patient with blood pressure fall during nighttime > 10% of daytime levels) versus "nondipper" status were made possible. This pilot study has been undertaken to investigate whether patients with recently discovered, never-treated, mild, sustained hypertension have cardiovascular abnormalities according to their dipper/nondipper status. Patients with long-standing (n = 123) and newly discovered (n = 56) sustained hypertension were classified according to their nighttime blood pressure fall, and compared with normotensive controls. Ambulatory blood pressure monitoring was performed noninvasively. Parameters of left ventricular structure, cardiac systolic and diastolic function, and carotid anatomy were determined noninvasively by echographic methods. Significant increases in parameters of cardiac structure as well as abnormalities in diastolic function were observed in patients with long-standing hypertension, regardless of their dipper status. In the group with newly discovered hypertension, left atrium (3.4+/-0.3, 3.7+/-0.5, 3.2+/-0.4 cm in dippers, nondippers, and controls, respectively), end-diastolic diameter index (2.9+/-0.3, 3.0+/-0.2, 2.8+/-0.2 cm/m), and atrial filling fraction (0.50+/-0.07, 0.52+/-0.05, 0.42+/-0.04) were significantly altered only in the nondipper subgroup, in comparison with controls. Significant changes in cardiac structure and diastolic function were observed in nondipper patients with recently discovered hypertension, who, at variance with dippers, show changes similar to those in patients with long-standing hypertension. Hypertensives with the observed abnormalities may benefit from active antihypertensive treatment, which appears, therefore, justified even in an early phase of mild hypertension, in terms of potential reduction of end-organ complications as well as cost-effectiveness.

Serum cholesterol affects blood pressure regulation.

A close relationship between abnormalities of the lipid metabolism and arterial hypertension has been observed in several epidemiological studies. The aim of the present study was to investigate whether serum cholesterol might affect blood pressure (BP) levels at rest, during ambulatory monitoring or during sympathetic stimulation-independently of other variables such as body weight or serum insulin-thus influencing the outcome of hypertensive complications. Seventy-three patients with sustained newly-discovered and never-treated hypertension were divided into tertiles according to their serum cholesterol levels and their resting BP, 24-h BP and BP during isometric exercise (handgrip) were compared. Cardiac mass and carotid wall thickness were measured by echographic technique. The results were that tertiles were similar for body weight, blood glucose and serum insulin, but different for serum cholesterol and triglycerides. BP at rest and during 24-h monitoring was similar in the three groups, whilst a significant difference was detected during sympathetic stimulation by handgrip, with systolic and diastolic BP increasing by 16/12, 28/19 and 30/23 mm Hg (P < 0.01) in lower, medium and higher tertiles, respectively. Intima-media layer of the carotid arteries was also significantly thickened in the groups with higher cholesterol levels (0.54 +/- 0.07, 0.67 +/- 0.14, 0.68 +/- 0.15, P < 0.05). These data support the conclusion that even in patients with recently discovered hypertension, cholesterol levels may influence the BP response to adrenergic stimulation as well as the outcome of target organ disease.

Effects of Isradipine on 24-h Blood Pressure, Left Ventricular Hypertrophy and Hemodynamics in Type II Diabetic Hypertensive Patients.

The effects of 5 mg slow-release isradipine given once daily for both office-taken and monitored 24-h blood pressure, left ventricular mass and forearm hemodynamics have been evaluated by noninvasive methods for 6 months in 12 type II diabetic patients aged 40--60 years with concomitant arterial hypertension of mild to moderate degree. A significant reduction in both supine (from 164/96 to 146/85 mmHg) and standing blood pressure (from 164/100 to 143/89 mmHg) was observed at the end of the treatment period. A slight reduction was detected in walking blood pressure and a more marked reduction in sleeping blood pressure measured by an ambulatory blood pressure monitoring system, although the statistical significance was only approached because of the huge daily variability in blood pressure levels. A significant reduction in left ventricular mass index was detected by M-mode echocardiography (from 153 plus minus 72 to 122 plus minus 84 g/m(2) body surface area) without any impairment of left ventricular systolic function. Brachial artery compliance was not significantly increased (from 1.86 plus minus 0.7 to 2.21 plus minus 0.9 cm(4) center dot dyne(minus sign1) center dot 10(7)) and impedance slightly but nonsignificantly reduced (from 99.6 plus minus 52 to 65.7 plus minus 13 dyne(5) center dot cm(minus sign5) center dot 10(2)) by the treatment. These results show that long-term isradipine treatment reduces blood pressure values and left ventricular hypertrophy. However, the findings of this study need to be confirmed in a larger population sample in order to establish whether isradipine really improves the overall cardiovascular risk profile.

A contemporary analysis of acute mastoiditis.

BACKGROUND: Acute mastoiditis persists as a serious infection despite a dramatic decline in incidence coincident with the introduction of antibiotic therapy. OBJECTIVE: To assist the contemporary practitioner in the recognition and management of acute mastoiditis through the assessment of a large series of patients. DESIGN: Retrospective case series comprising 124 patients with acute mastoiditis. SETTING: Pediatric and adult otology referral center. MAIN OUTCOME MEASURES: Selected clinical parameters. Risk factors for necessity of surgical intervention and for increased length of hospitalization were analyzed by a stepwise logistic regression model. RESULTS: A history of antecedent acute otitis media was absent in 45% of patients. Pain (98%) was the most common presenting symptom. Physical signs included an abnormal-appearing tympanic membrane (88%), fever (83%), a narrowed external auditory canal (80%), and postauricular edema (76%). Streptococcus pneumoniae was the most commonly isolated organism. Mastoid surgery was required in 62% of the patients. An elevated white blood cell count (relative risk [RR], 7.4; P < .01), proptosis of the auricle (RR, 4.5; P = .03), and fever on admission (RR, 7.3; P = .05) were risk factors for surgical intervention. All 33 patients with complications (27%) proceeded to surgical intervention. The average length of hospital stay was 7.9 days. The strongest predictor for an increased length of hospital stay was whether the patient required surgery (RR, 3.7; P = .002). CONCLUSIONS: Acute mastoiditis remains a potentially serious otologic infection. Not all patients present with a classic history or physical examination. Therapeutic mastoidectomy is often required.

[Cardiovascular response to the cold test in obese subjects. Effect of a hypocaloric, normal sodium diet]. / Risposta cardiovascolare al "test al freddo" in soggetti obesi. Effetto della dieta ipocalorica normosodica.

Loss of weight in obese patients, both hypertensive and normotensive, causes a fall in blood pressure (BP) through a mechanism which is still not fully understood. The effects of a low-sodium low-energy diet on BP were assessed in 20 obese subjects (15 M and 5 F; age 26-65 years), 11 of whom were normotensive and 9 hypertensive. Following a period of normocaloric diet, a diet of 600 kcal was prescribed for 6 months. BP and heart rate (HR) were measured at the start and end of hypocaloric diet in resting conditions and during stimulation of the adrenergic nervous system (ANS) obtained by exposure to cold (immersion of the hand in water and ice). A reduction of resting BP (from 137/81 +/- 5/4 to 122/74 +/- 4/4 mmHg, p less than 0.05) was observed in 8 patients who lost at least 30% of excess weight (from kg 107 +/- 6 to 91 +/- 4, p less than 0.001) together with an increase in BP during exposure to cold (from 140/82 +/- 3/3 to 156/95 +/- 7/4 mmHg before and from 120/78 +/- 3/4 to 140/88 +/- 3/3 after the diet, p less than 0.05). No changes were found in the daily urinary excretion of Na during the course of diet therapy. These results demonstrate that a hypocaloric diet, independent of saline restriction, is able to reduce resting BP and pressure peaks during adrenergic stimulation.

Investigation of freshwater sponges spicules deposits in a karstic lake in Brazil / Investigação de depósito de espículas de esponjas de água doce em um lago cárstico no Brasil

Abstract The environmental conditions which contributed to the formation of the notorious quaternary deposits of freshwater sponge spicules in karstic lentic environments in Brazil have been subject of some speculation. No investigation has yet been conducted to test whether these deposits currently originate in karstic lakes. To provide for such an investigation, Serra Negra Lake, which is formed on an ultramafic-alkaline-carbonatite dome at central western Brazil, close to the area of occurrence of the paleo-deposits was selected for the study. Bottom sediments were sampled at 10 stations across the lake, and water was sampled at five of the stations, in June/2011 (rainy season) and October/2011 (dry season). Analysis of granulometry, organic matter and presence of spicules were carried out in the sediments. Lake water was analysed for the main physical and chemical characteristics. Deposit of spicules was restricted to the northern area of the lake, which is rich in macrophyte. The taxonomic analysis of the spicules indicated the contribution of five sponge species, Dosilia pydanieli, Metania spinata, Radiospongilla amazonensis, Trochospongilla variabilis and Heterorotula fistula, which formed large deposits in neighbouring areas. The high silica concentration, derived from the dome volcanic rocks, constant water level and available substrate are credited for the continuous production of sponges and spicules, confirmed by the rare presence of gemmoscleres. The lake is classed as a minerotrophic fen type of bog with a heavy contribution from the surrounding creeks. Lake sediments are fine with high levels of organic matter and peat, which contributed to the trapping of spicules in the sediments.

Resumo As condições ambientais que contribuíram para a formação de notórios depósitos quaternários de espículas de esponjas de água doce em ambientes cársticos no Brasil têm sido objeto de algumas especulações. Nenhuma investigação foi ainda realizada para testar se esses depósitos originam-se atualmente em lagos cársticos. Para prover tal investigação, a Lagoa Serra Negra, formada em um domo ultramáfico-alcalino-carbonatítico, no centro oeste do Brasil, próximo à área de ocorrência dos referidos paleo-depósitos, foi selecionada para o estudo. Sedimentos de fundo foram amostrados em 10 estações ao longo do lago, e a água foi coletada em cinco das estações, em junho/2011 (estação chuvosa) e outubro/2011 (estação seca). Análises de granulometria, matéria orgânica e presença de espículas foram realizadas nos sedimentos. A água do lago foi analisada para as principais características físicas e químicas. O depósito de espículas foi restrito à área norte do lago, que é rico em macrófitas. A análise taxonômica das espículas indicou a contribuição de cinco espécies de esponjas, Dosilia pydanieli, Metania spinata, Radiospongilla amazonensis, Trochospongilla variabilis e Heterorotula fistula, que formaram grandes depósitos em áreas vizinhas. A alta concentração de sílica, derivada das rochas vulcânicas do domo, o nível constante da água e a disponibilidade de substrato são creditadas à produção contínua de esponjas e espículas, confirmada pela presença rara de gemoscleras. O lago é classificado como uma turfeira do tipo fen, minerotrófica, com forte contribuição dos arroios circundantes. Os sedimentos da lagoa são finos, com altos níveis de matéria orgânica e formação de turfa, o que contribuiu para a captura das espículas nos sedimentos.

Insulin resistance, ventricular mass and function in normoglycaemic hypertensives.

BACKGROUND AND AIM: To investigate the possible relationship between insulin sensitivity and the main non-invasively determined parameters of left ventricular structure and function in an early phase of hypertensive disease. METHODS AND RESULTS: We studied a group of 60 patients with previously untreated primary arterial hypertension of recent onset. Insulin sensitivity was evaluated by means of homeostasis model assessment (HOMA), and cardiac structure and function by means of ultrasonography. The patients were subsequently divided on the basis of HOMA tertiles and the between-group differences were statistically evaluated using one-way analysis of variance. No difference was found in the main demographic parameters, but high-density lipoprotein (HDL)-cholesterol was significantly higher (1.43 +/- 0.4, 1.16 +/- 0.2, 1.16 +/- 0.2 mmol/L; p < 0.05) and total triglycerides significantly lower (0.94 +/- 0.3, 1.41 +/- 0.8, 1.54 +/- 0.7 mmol/L; p < 0.05) in the first tertile. In relation to the non-invasive parameters of diastolic function, the E wave was significantly reduced in the third tertile (0.64 +/- 0.1, 0.63 +/- 0.1, 0.52 +/- 0.1 m/s; p < 0.05), with a concomitant significant increase in AFF (0.51 +/- 0.03, 0.51 +/- 0.06, 0.56 +/- 0.03; p < 0.05). The E wave (r = 0.326, p < 0.05), E/A wave ratio (r = -0.277, p < 0.05) and AFF (r = 0.432, p < 0.001) were significantly related to HOMA, regardless of age, body mass index, heart rate, left ventricular mass and blood pressure. CONCLUSIONS: Our results indicate that hypertensive patients in the third HOMA tertile (i.e. those with reduced insulin sensitivity) have early diastolic left ventricular abnormalities.

[Changes in the blood zinc in the irritable bowel syndrome: a preliminary study]. / Alterazioni della zinchemia nella sindrome dell'intestino irritabile: studio preliminare.

Having outlined the important role played by zinc in the human metabolism and the alteration which may occur as a result of a zinc deficit, the paper reports a study of 50 patients affected by irritable bowel syndrome. Two subgroups have been identified (Ac and Ad), characterised by reduced blood zinc [correction of zinchemia] and increased fecal excretion of zinc. This finding suggests that the syndrome has a multifactorial pathogenesis and that over time it may follow a different pattern in the different subgroups.

Cardiovascular response to adrenergic stimulation during treatment with tertatolol. A new non-cardioselective beta-blocking agent in primary hypertensive patients.

The antihypertensive effects of tertatolol, a new non-cardioselective beta-blocking drug, were investigated in 20 patients with mild to moderate primary arterial hypertension, in a placebo controlled double blind randomized study. After tertatolol 5 mg o.d. significant decreases in both systolic and diastolic blood pressure and in heart rate were observed at rest (BP from 155/103 +/- 3/1 to 139/91 +/- 4/3 mmHg p less than 0.01; HR from 79 +/- 2 to 60 +/- 2 bpm p less than 0.01). Peak blood pressure, heart rate and myocardial O2 consumption, indirectly measured as cardiac workload, determined during adrenergic stimulation by 70 degrees head-up tilt, cold pressor test, mental arithmetic stress, isometric exercise and bicycle exercise were also reduced by 4 weeks of tertatolol treatment in comparison to pretreatment levels. No significant changes in the same parameters were induced by placebo. No side effects were observed during treatment.

Long-term magnesium supplementation in essential hypertension.

The main objective of this clinical trial was to evaluate the effects of magnesium pidolate (15 mmol/day) on blood pressure at rest and during sympathetic stimulation induced by cold, isometric and tilt test; peripheral blood flow has been evaluated by strain-gauge plethysmography. Fourteen mild to moderate hypertensives (8 males, 6 females, age range 40-60 years) were randomly given magnesium or placebo in a double-blind parallel clinical trial for 6 months. In the actively treated group magnesium urinary excretion increased from 5.3 +/- 2 to 7.7 +/- 2 mmol/24 h, and serum magnesium changed from 0.9 +/- 0.1 to 1.0 +/- 0.2 mmol/l. On magnesium, BP changed at rest from 156/97 +/- 12/4 to 149/90 +/- 8/3 mm Hg, during cold pressor test from 169/105 +/- 9/6 to 174/105 +/- 15/4, during isometric exercise from 170/107 +/- 13/9 to 170/105 +/- 20/6, and during tilt test from 149/96 +/- 11/6 to 153/96 +/- 17/7 mm Hg. Similar changes were observed in the placebo group. Peripheral resistances were 14.7 +/- 4 and 9.8 +/- 2 PRU before and after magnesium, respectively. These data indicate that long-term magnesium pidolate supplementation does not affect blood pressure at rest and during sympathetic stimulation, despite a slight, nonsignificant reduction in forearm peripheral resistance.

Carotid diameter and blood flow velocities in cerebral circulation in hypertensive patients.

BACKGROUND AND PURPOSE: The recent development of noninvasive techniques for the evaluation of the carotid arteries has focused attention on the study of arterial wall thickness to identify early lesions of vessels in patients at high risk for atherosclerosis, such as those with hypercholesterolemia, diabetes mellitus, and hypertension. METHODS: In a sample of 70 hypertensive patients without clinical evidence of target organ damage, we showed a thickening of the intimal plus medial layers compared with age- and sex-matched normotensive control subjects. In this sample we also studied the diameter of the carotid arteries by ultrasound imaging, and we studied flow velocities in common carotid, internal carotid, and middle cerebral arteries by Doppler technique. Pulsatility and resistance indexes were calculated. RESULTS: Absolute values of the carotid diameter were similar in the two groups (6.3 +/- 0.7 versus 6.0 +/- 0.8 mm); however, the ratio of diameter to blood pressure was significantly reduced in hypertensive compared with normotensive subjects (5.3 +/- 0.7 versus 6.5 +/- 0.8; P < .001 for mean blood pressure). Parietal stress was increased in the hypertensive subgroup and significantly correlated with arterial diameter in the normotensive group but not in the hypertensive group. No significant differences between the two groups were observed in blood flow velocities, with the exception of a slight significant increase of mean velocity in the internal carotid artery in hypertensive patients (37.5 +/- 9.1 versus 32.7 +/- 3.0 cm/s; P < .02). CONCLUSIONS: These results indicate that in addition to the degenerative changes of the common carotid wall, the diameter of the carotid artery and the relation to parietal stress show an early impairment in patients with uncomplicated hypertension.

Early changes of the arterial carotid wall in uncomplicated primary hypertensive patients. Study by ultrasound high-resolution B-mode imaging.

Arterial hypertension is frequently responsible for arteriosclerotic damage in the carotid region. Nevertheless, there is as yet no general agreement that hypertension is correlated with lesions detected by noninvasive means in the carotid arteries. We studied, by noninvasive echotomographic technique, 70 uncomplicated primary hypertensive individuals without clinically evident end-organ complications and 30 normotensive matched control subjects to detect early lesions of carotid arteries. The presence of other cardiovascular risk factors was assessed, and heart structure and function were studied by echocardiography. Although hypertensive individuals were comparable to control subjects for other risk factors, they showed a marked increase in the thickness of the intimal-medial complex of the carotid wall (0.71 +/- 0.4 versus 0.56 +/- 0.2 mm, P < .001 in the right carotid and 0.83 +/- 0.3 versus 0.58 +/- 0.2, P < .003 in the left), in left ventricular mass (203 +/- 52 versus 176 +/- 37 g, P < .05), and in the prevalence of definite plaques of the carotid wall, both monolaterally and bilaterally (P < .003 by chi 2 test). Among the different factors contributing to the increase in thickness of the carotid artery wall, standing blood pressure, serum triglycerides, and age were found to be the best predictors (they accounted for about 16% of the variability, P < .005). These results indicate that carotid arteries of hypertensive individuals undergo degenerative changes, just as shown for hypercholesterolemic and diabetic patients in other studies. This supports the use of B-mode ultrasound imaging to detect early involvement of the carotid region before the appearance of any end-organ damage of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)