ORIGINAL ARTICLE Association between pulse pressure, carotid intima–media thickness and carotid and/or iliofemoral plaque in hypertensive patients J-M Tartie `re 1 , L Kesri 1 , H Safar 2 , X Girerd 2 , M Bots 3 , ME Safar 2 and J Blacher 2 1 Department of Cardiology, Beaujon Hospital, Clichy, France; 2 Department of Internal Medicine, Broussais Hospital, AP-HP, Paris, France; 3 Universitair Medisch Centrum, Utrecht, the Netherlands Increased common carotid artery intima–media thick- ness (CCA-IMT) and carotid and/or iliofemoral (C/IF) plaque are frequent in subjects treated for hypertension, but their association with pulse pressure (PP) has rarely been studied. Using ultrasound techniques, CCA-IMT and C/IF plaques were studied in 323 hypertensive subjects, who were classified into four groups accord- ing to the adequacy of blood pressure (BP) control (systolic BP (SBP) o140 mmHg and diastolic BP (DBP) o90 mmHg) and PP (high or low). After adjustment for confounding variables, an increase in CCA-IMT was the only factor significantly and independently associated with high PP, irrespective of the effectiveness of blood pressure control and of antihypertensive drug treat- ment. CCA-IMT correlated with age, PP, waist-to-hip ratio, tobacco consumption, and heart rate. C/IF plaques correlated with age, tobacco consumption, diabetes mellitus, and dyslipidaemia. To conclude, even with SBPo140 mmHg and DBPo90 mmHg on treatment, hypertensive subjects may have increased CCA-IMT values and C/IF plaque. Four cardiovascular risk factors seem to be involved in these alterations, namely tobacco consumption, dyslipidaemia, diabetes and in- creased PP. Only the latter factor does not have a standardized effective treatment. Journal of Human Hypertension (2004) 18, 325–331. doi:10.1038/sj.jhh.1001673 Published online 29 January 2004 Keywords: atherosclerosis; pulse pressure; arterial thickness; arterial plaques Introduction Increased common carotid artery intima–media thickness (CCA-IMT) and presence of arterial pla- ques are significantly associated with cardiovascu- lar risk factors. 1–6 In most recent prospective studies, CCA-IMT and/or aortic abdominal calcifications significantly predicted the occurrence of cardiovas- cular events. 7,8 PP, a significant independent marker of cardiovascular mortality, 9,10 has been found in many experimental and clinical studies to modulate IMT. 11–14 The EVA study 12 showed both cross- sectional and longitudinal associations between brachial PP and CCA-IMT in humans. Moreover, CCA-IMT and plaques seem to be complementary in the assessment of cardiovascular risk in hypertensive patients. 15 We have postulated that CCA-IMT and arterial plaques could correlate differently with cardiovascular risk factors. We examined treated and untreated hypertensive subjects in order to determine the crude and adjusted association between CCA-IMT or carotid and/or iliofemoral (C/IF) plaques and blood pressure (BP). Hypertensive subjects were classified not only according to the adequacy of BP control (systolic BP (SBPo140 mmHg and diastolic BP (DBP) o90 mmHg) but also according to the presence of low or high (460 mmHg) pulse pressure (PP) on drug treatment. We therefore analysed many of the factors influencing CCA-IMT, carotid geometry, and C/IF plaques, and specifically their relationship with PP. Methods Study cohort From December 2000 to June 2001, around 400 patients attended the Department of Internal Med- icine of Broussais Hospital for a cardiovascular Received 30 June 2003; revised 03 November 2003; accepted 11 November 2003; published online 29 January 2004 Correspondence: Dr J-M Tartie `re, Ho ˆ pital Beaujon, Service de Cardiologie, 100 Bd Gal Leclerc, Clichy 92118, France. E-mail: jean-michel.tartiere@bjn.ap-hop-paris.fr Journal of Human Hypertension (2004) 18, 325–331 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $25.00 www.nature.com/jhh