Association between hypertension and carotid plaque vulnerability: a Chinese Atherosclerosis Risk Evaluation II study

To investigate the associations of hypertension and blood pressure control status with carotid vulnerable plaque features in symptomatic patients using magnetic resonance (MR) vessel wall imaging. This retrospective cross-sectional analysis used data from the multicenter Chinese Atherosclerosis Risk Evaluation II (CARE II) study. Patients with recent cerebrovascular symptoms and ultrasound-detected plaques underwent carotid MR vessel wall imaging. Participants were classified as non-hypertensive (non-HTN) or hypertensive (HTN); HTN was further divided into controlled and uncontrolled subgroups. Carotid plaque burden (lumen area, wall area, total vessel area, maximum wall thickness, and normalized wall index [NWI]), plaque composition (calcification [CA], lipid-rich necrotic core [LRNC], intraplaque hemorrhage [IPH], and fibrous cap rupture [FCR]), and high-risk plaque (HRP) were assessed. Multivariable regression adjusted for clinical confounders compared groups. A total of 584 patients were included, of whom 436 (74.66%) had hypertension. Among hypertensive patients, 82 (18.81%) had controlled hypertension and 354 (81.19%) had uncontrolled hypertension. The HTN group showed greater wall area, total vessel area, maximum wall thickness, and NWI (all P < 0.05), as well as higher prevalence of CA and LRNC (both P < 0.05). In subgroup analysis, controlled hypertension was associated with higher prevalence of CA, LRNC, IPH, and HRP (all P < 0.05). After adjustment, the difference in LRNC prevalence between HTN and non-HTN groups remained significant (adjusted OR = 1.559, 95% CI: 1.029–2.363; P = 0.036). Hypertension is associated with greater carotid plaque burden and vulnerability, especially LRNC, which remained independently associated with hypertension after adjustment for confounders; plaque characteristics also differed according to current blood pressure status.