Long-term changes in carotid intima-media thickness according to baseline blood pressure level: J-STARS Echo study

Shinichi Wada; Masatoshi Koga; Tatsuo Kagimura; Kazunori Toyoda; Yoji Nagai; Shiro Aoki; Tomohisa Nezu; Naohisa Hosomi; Hideki Origasa; Toshiho Ohtsuki; Hirofumi Maruyama; Masahiro Yasaka; Kazuo Kitagawa; Shinichiro Uchiyama; Kazuo Minematsu; Masayasu Matsumoto; Japan Statin Treatment Against Recurrent Stroke (J-STARS) Echo Study Collaborators

doi:10.1016/j.jns.2024.123342

Long-term changes in carotid intima-media thickness according to baseline blood pressure level: J-STARS Echo study

J Neurol Sci. 2024 Dec 9:468:123342. doi: 10.1016/j.jns.2024.123342. Online ahead of print.

Authors

Shinichi Wada¹, Masatoshi Koga², Tatsuo Kagimura³, Kazunori Toyoda⁴, Yoji Nagai⁵, Shiro Aoki⁶, Tomohisa Nezu⁶, Naohisa Hosomi⁷, Hideki Origasa⁸, Toshiho Ohtsuki⁹, Hirofumi Maruyama⁶, Masahiro Yasaka¹⁰, Kazuo Kitagawa¹¹, Shinichiro Uchiyama¹², Kazuo Minematsu¹³, Masayasu Matsumoto¹⁴; Japan Statin Treatment Against Recurrent Stroke (J-STARS) Echo Study Collaborators

Affiliations

¹ Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.
² Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: [email protected].
³ Foundation for Biomedical Research and Innovation at Kobe, Translational Research Center for Medical Innovation (TRI), Kobe, Japan.
⁴ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
⁵ Department of Clinical Research Facilitation, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan.
⁶ Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
⁷ Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan; Department of Neurology, Chikamori Hospital, Kochi, Japan.
⁸ The Institute of Statistical Mathematics, Tokyo, Japan.
⁹ Stroke Center, Kindai University Hospital, Osakasayama, Japan.
¹⁰ Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
¹¹ Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
¹² Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Medical Center, Tokyo, Japan.
¹³ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Headquarters, Medical Corporation ISEIKAI, Osaka, Japan.
¹⁴ Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Neurology, Iseikai Hospital, Osaka, Japan.

PMID: 39673820
DOI: 10.1016/j.jns.2024.123342

Abstract

Background and aims: We aimed to investigate long-term changes in carotid intima-media thickness (IMT) based on baseline blood pressure (BP) levels in non-cardioembolic stroke patients.

Methods: Patients aged 45-80 years with dyslipidemia who were not on statins before enrollment and had experienced a non-cardioembolic stroke were assigned to either the pravastatin group or the control group in a randomized trial. Patients were classified into three groups according to BP levels: normal BP (N-group: systolic BP [sBP] <140 mmHg and diastolic BP [dBP] <90 mmHg), highly elevated BP (G2 group: sBP ≥160 mmHg or dBP ≥100 mmHg), and mildly elevated BP (G1 group: the remaining patients). Mixed effect models were used to examine differences in slope of mean carotid IMT increases annually over the 5-year observation period among three groups, and for two groups divided based on whether they were above or below certain BP cut-off levels set at every 1 mmHg, ranging between 139 and 161 mmHg for sBP, and 89-101 mmHg for dBP.

Results: Of 792 patients, baseline mean carotid IMT in the G1-group (0.908 ± 0.152 mm) and G2-group (0.905 ± 0.145 mm) was significantly higher than the N-group (0.870 ± 0.153 mm) (P < 0.01, for both respectively). Although there was no significant difference in the increase among three groups (P = 0.091), the increase in patients above sBP 154, 159 and 160 mmHg or dBP 101 mmHg at baseline was higher than others (P < 0.05 for all).

Conclusions: High baseline BP correlated with a high baseline carotid IMT and its subsequent 5-year increase in non-cardioembolic stroke patients.

Clinical trial registration: http://www.

Clinicaltrials: gov.

Unique identifier: NCT00361530.

Keywords: Blood pressure; Intima-media thickness; Statin; Stroke; Ultrasound.

Associated data

ClinicalTrials.gov/NCT00361530