| Background: Essential hypertension as an important factor causing cardiac and cerebrovascular disease has been approved. There is a positively relationship between the incidence of cardio-cerebrovascular disease and essential hypertension. Carotid artery intima-media thickness(IMT) and plaque are relative to the risk factors such as hypertension and hyperlipidemia. Controling these risk factors will make the carotid artery IMT and plaque stable. Ultrasonography detecting the carotid artery IMT is an effective and no damage method that can also show the atherosclerosis of cerebral and cardiac artery. There are 120 million patients with essential hypertension in our country. Hypertension is the most important risk factor of stroke. But it is not clear by now that whether the intervention of lipid regulation therapy can reduce the incidence of stroke accompanied with essential hypertension.Objectives: Using Doppler ultrasonography and cerebrovascular hemodynamics analysis (CVA) the author from various angles dynamically overall surveyed the changes of the carotid artery IMT, atherosclerotic plaque and CVA. From the lipid metabolism, the artery endothelial function, cerebrovascular hemodynamics analysis and relationship between carotid artery IMT and plaque the author studied essential hypertension, the formation and development of carotid atherosclerosis and it' s effects on CVA; investigated the correlations among blood pressure, carotid artery IMT and CVA; observed andevaluated the effects of the intervention of lipid regulation on essential hypertension, carotid artery IMT and CVA. Expectanly, with the intervention of lipid regulation the patients' carotid artery IMT and plaque in essential hypertension could be stablized, the cerebrovascular hemodynamics analysis improved, the incidence, disability and mortality of essential hypertensive patients complicated with stroke decreased.Methods: 586 patients with essential hypertension were separated into three groups according to the criteria made by WHO/ISH, grade 1 172 cases, grade 2 298 cases, grade 3 116 cases as well as 200 healthy control subjects. Carotid artery IMT, IMT/D ratio, the shape and degree of plaque, extent of blood vessel stenosis and blood flow, CVA, serum lipids, cellular adhesive molecule and the endothelial function of blood vessel were detected by America ATL-HDI 5000 color-Doppler ultrasonography, LH-450 cerebrovascular hemodynamics analysis, Olympus Au6000 auto-biochemistry analysis and 550 enzyme facilities. 207 patients with essential hypertension were performed by the intervention of lipid regulation at the same time of controlling blood pressure. The patients were assigned to receive micronised fenofibrate (200mg/d, n=102) in combination with anti-hypertensive treatment or anti-hypertensive treatment alone (n=105) for 18 months. Carotid artery IMT and plaque were examed using color-Dopier ultrasonography, CVA and the levels of serum lipids were measured before and after the trial.Results: 1. Carotid artery ultrasonography detecting: (1) Carotid artery IMT was more significantly increased in patients with deferent grades of hypertension than the healthy control group (P<0.05); there was also significant increase in carotid artery IMT among patients with deferent grades of hypertension. The higher blood pressure the thicker carotid artery IMT. (2) The incidence of carotid artery plaque was much higher in hypertension than that in the control group (P<0.05). In grade 2 the incidence of carotid artery plaque formation categorized 1 , 2, 3 degrees all were significantly higher than that of grade 1 (P<0.01).In grade 3 the incidence of carotid artery plaque formation categorized 2> 3 degrees were significantly higher than that of grade 2 group (P<0.05~0.01).The highest incidence of degree 1 carotid artery plaque formation was in the grade 2 group (23.15%); the incidence of degree 2> 3 carotid artery plaque formation was highest in grade 3 group (25.86% and 36.21% respectively). The classification and incidence of carotid artery plaque increased following the blood pressure level. (3) The 1> 2* .3 degrees of carotid artery plaque were different in about 49.57%, 51.81% and 55.01% in patients with hypertension when carotid artery IMT > 1.00 mm, while the 1> 2- 3 degrees of carotid artery plaque were only in about 9.0%, 8.0 and 2.3% when carotid artery IMT <0.80 mm and there were approximately 80.13% patients who had no carotid artery plaque. (4) The carotid artery plaque most frequently located in bifurcation of common carotid artery ( 54.56%), the beginner of intro-carotid artery (26.12%), and the extra-carotid artery (5.70%); the style of carotid artery plaque were flat (41.36%), hard (34.18%), soft and ulcer (16.19% and 8.27%). 2. Cerebrovascular hemodynamics analysis (CVA) testing: (1) Vmean and Qmean were much reduced while R, Zc'Wv, DR and CP were significantly increased in patients with hypertension than that of controls. The above parameters in different grade of hypertensive patients were different significantly too (P<0.05~0.01). The patients' Vmean and Qmean were gradually decreased while Zc, Wv and DR were gradually increased as the hypertension became more severe. (2) In CVA detectings all parameters except CP were significantly different in different carotid artery IMT groups(P<0.01). As increasing with carotid artery IMT, the Vmean and Qmean were decreased while R, Zc Wv and DR were increased. (3) Vmean and Qmean in carotid artery plaque degree 2 and 3 were markedly lower than that in degree 0 and 1, while R, Zc , Wv and DR were markedly higher, moreover, Wv among all degrees showed significantly different (P<0.01). 3 Correlation and multifactorial regressive analysis between carotid artery IMT and CVA showed: (1) Carotid artery IMT and IMT/D ratio were markedly negative linearcorrelation with Vmean and Qmean while markedly positive linear correlation with R, Zc, Wv and DR (p<0.01). (2 ) All grades in hypertensive patients and all degrees in carotid artery plaque were markedly negative linear correlation with Vmean and Qmean, while markedly positive linear correlation with R, Zc, Wv and DR (P<0.05~0.01). (3) Spearman' s correlation analysis showed that systolic blood pressure, the serum levels of TC, TG, OX-LDL, ApoB100 and P-sel were markedly positive correlation with carotid artery IMT; while the serum levels of HDL-C and ApoAI were markedly negative correlation with carotid artery IMT(p<0.01). 4. The intervention of lipid regulation: (1) The IMT of hypertensive patients was basically stable after 18 months of intervention therapy with micronised fenofibrate. CCAIMT and ICAIMT were not significantly difference befor and after the trial, while in control group CCAIMT was increased by 0.052 ± 0.012 mm which was significantly difference in comparison with pretrial (P<0.05). (2) In intervention group CCAIMT/D ratio and ICAIMT/D ratio were significantly decreased and in control group ICAIMT/D ratio was increased significantly after the trial (P<0.05). (3) The incidence of carotid artery plaque was not significantly changed in intervention group, while the incidence of carotid artery plaque was markedly increased in control group (P<0.05). (4) Vmean and Qmean were markedly increased in intervention group, while R, Zc, Wv and DR were all markedly decreased (P<0.05~0.01). R.,Zc ,Wv and DR were markedly increased while Vmean and Qmean were markedly decreased after the trial in control group (P<0,05). (5) All the criteria of CVA whatever the IMT< 1.00mm or > 1.00mm showed markedly improved after the intervention of lipid regulation. (6) The serum levels of TC, TG, LDL-C,OX-LDL, ApoB100 and P-sel were all decreased whill HDL-C, ApoAI and NO markedly increased after the trial (P<0.05~0.01). (7) The incidence of stroke in intervention group was significantly lower (10.78%) than that of controls (22.55%) and Logistic regression survival analysis showed that the incidence, disability and mortality of stroke were markedly decreased to 34%, 27% and 25% respectively...
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