Effect of Hypertension on Carotid Plaque Formation and Outcomes in High-Risk Cerebrovascular Population: A Community-Based Study in Guangzhou

Objective: This study investigates the effects of hypertension on carotid plaque formation and clinical outcomes in a high-risk population for cerebrovascular disease in the Guangzhou communities. Methods: Data from 322 high-risk individuals for cerebrovascular disease in the Guangzhou communities were consecutively collected between January 2018 to December 2023. These participants were hospitalized twice within one year at the Department of Neurology, the First Affiliated Hospital of Guangzhou Medical University, and underwent carotid ultrasound examinations during both admissions. Based on the carotid ultrasound results from the first hospitalization, participants were initially categorized into two groups (with or without plaque) to analyze the association between hypertension and carotid plaque formation using univariate and multivariate methods. Subsequently, the cohort was further divided into three groups according to hypertension control status across both admissions: a non-hypertensive group (n = 48), a hypertension controlled group (average blood pressure (BP) < 130/80 mmHg at both admission, n = 109), and a hypertension uncontrolled group (average BP ≥ 130/80 mmHg at either admission, n = 165). Differences in the variance of Crouse scores (ΔCrouse) between the two ultrasound examinations were analyzed among the three groups. Further stratification analysis was performed by dividing participants into two age subgroups (cutoff: 70 years) and three hypertension control subgroups (average BP < 130/80 mmHg at two-time admissions, one-time admission, or neither). The differences in ΔCrouse were then analyzed across these stratified subgroups. Results: Age (OR = 1.074, P = 0.000), gender (OR = 0.340, P = 0.000), SBP (OR = 1.039, P = 0.006), and DBP (OR = 0.932, P = 0.003) were significantly associated with carotid plaque formation. No statistically difference in ΔCrouse was observed between the hypertension controlled group and the non-hypertensive group; however, ΔCrouses in the above two groups showed significant differences from that in hypertension uncontrolled group (both, P < 0.01). Furthermore, similar trends were found in both age subgroups (≥ 70 years and < 70 years). The two-time controlled hypertension subgroup exhibited significantly smaller ΔCrouse value than the one-time and two-time uncontrolled subgroups (both, P < 0.05), while no significant difference was found between the one-time and two-time uncontrolled subgroups. Conclusions: Age, gender, SBP, and DBP were identified as influential factors for carotid plaque formation. In patients with well-controlled hypertension (average BP < 130/80 mmHg), the progression rate of carotid plaques showed no significant difference from that of non-hypertensive individuals. However, the progression of carotid plaques was significantly accelerated in patients with uncontrolled hypertension.