ORIGINAL ARTICLE Associations of blood pressure with carotid intima-media thickness in elderly Finns with diabetes mellitus or impaired glucose tolerance U Rajala 1,3 , M Pa ¨iva ¨nsalo 2 , M Laakso 1,3 , O Pelkonen 2 , I Suramo 2 and S Keina ¨nen- Kiukaanniemi 1,3 1 Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland; 2 Department of Diagnostic Radiology, University of Oulu, Oulu, Finland; 3 Unit of General Practice, Oulu University Hospital, Oulu, Finland The aim of the present study was to evaluate the associations of ultrasonographic manifestations of carotid atherosclerosis with systolic (SBP) and diastolic blood pressure (DBP) and pulse pressure (PP) in 65- year-old Finns drawn from a population-based cohort. Carotid ultrasonographic measurements were per- formed on 54 diabetic subjects, 97 subjects with impaired glucose tolerance (IGT) and 57 normoglycae- mic subjects (NGT). The subjects were classified into four quartiles of SBP, DBP and PP. SBP, DBP, PP and the use of antihypertensive drugs increased along with the deterioration of glucose status. The maximal intima-media thickness (IMT) of the common carotid artery (CCA) from the lowest to the highest quartiles of SBP was 0.98 7 0.34, 1.00 7 0.35, 1.03 7 0.29, 1.18 7 0.52 mm (P ¼ 0.038), respectively. SBP was higher (161 7 22 mmHg) in the subjects with severe intima- media thickening (maximal IMT CCA X1.2 mm) than in those with maximal IMT CCA of o1.2 mm (153 7 20 mmHg) (P ¼ 0.030). DBP and PP tended to be higher in the former than the latter group (DBP: 89 7 9 mmHg vs 86 7 9 mmHg, P ¼ 0.055 and PP: 72 7 18 mmHg vs 67 7 17 mmHg, P ¼ 0.159). The prevalence of severe intima-media thickening was 39% in the subjects in the highest SBP quartile (X170 mmHg) and 20% in the subjects with lower SBP (P ¼ 0.008). In multiple regres- sion analysis, the adjusted OR for severe intima-media thickening was 2.9 (95% CI 1.1–7.9) in the subjects in the highest SBP quartile compared to the subjects with lower SBP. In the present study, high SBP was associated with severe carotid intima-media thickening. We suggest that the results can be generalized to apply to elderly Finnish subjects with DM and IGT, but not to normoglycaemic subjects, on the basis of this study. Journal of Human Hypertension (2003) 17, 705–711. doi:10.1038/sj.jhh.1001594 Keywords: systolic blood pressure; intima-media thickening; carotid artery; diabetes mellitus; impaired glucose tolerance Introduction Hypertension plays an important role in the devel- opment of atherosclerosis, and the two processes have been suggested to have a common underlying mechanism. 1,2 According to several prospective population studies, systolic hypertension may be a more important cardiovascular risk factor than diastolic hypertension. 3–10 Systolic blood pressure (SBP) level rises progres- sively with age as a result of increasing arterial stiffness. 4,8,11,12 Diastolic blood pressure (DBP) peaks earlier and declines after the age of 55 years in men and 60 years in women. As a consequence, pulse pressure (PP), that is, the difference between SBP and DBP, increases with age. 8 Some recent epide- miological studies have reported that elevated PP predicts cardiovascular disease and mortality in middle-aged and elderly adults. 7–9,13–16 In accordance with the above-mentioned facts, some cross-sectional 17–21 and prospective 22 studies have shown that SBP may be a more important risk factor than DBP for early atherosclerotic manifesta- tions, including carotid intima-media thickening. Also, PP has been associated with the carotid intima-media thickness (IMT) in cross-sectional studies, 17,20,23 and it has predicted the progression of carotid IMT in some prospective studies. 22,23 Received 3 March 2003; revised 15 May 2003; accepted 26 May 2003 Correspondence: Dr U Rajala, Department of Public Health Science and General Practice, University of Oulu, Aapistie 1, 90220 Oulu, Finland. E-mail: urajala@cc.oulu.fi Journal of Human Hypertension (2003) 17, 705–711 & 2003 Nature Publishing Group All rights reserved 0950-9240/03 $25.00 www.nature.com/jhh