There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima–media thickness in hypertensive patients

  • Ayse Selcan Koc
  • Ferıde Fatma Gorgulu
  • Yurdaer Donmez
  • Yahya Kemal Icen
Original Article



There are limited data about increased aortic intima–media thickness (A-IMT) in the presence of subclinical target organ damage in hypertensive (HT) patients. In this study, we aimed to determine the frequency of increased A-IMT, the parameters determining increased A-IMT, and the relationship between increased A-IMT and other vascular IMT measurements.

Materials and methods

We prospectively included 265 patients (mean age 54.1 ± 10.6 years, male/female 91/174) with essential HT. Physical examination of all patients was performed. Laboratory data and antihypertensive treatments were recorded. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed. Bilateral carotid, brachial, and femoral artery and abdominal A-IMT values were measured by B-mode ultrasonography (USG). Patients were categorized into two main groups: patients with increased A-IMT (≥ 3 mm) or normal A-IMT (< 3 mm).


Increased A-IMT was detected in 55 patients (20.8%). There was a close relationship between increased A-IMT and advanced age, presence of coronary artery disease, high morning blood pressure surge (MBPS), and bilateral carotid and femoral IMT. Parameters associated with increased A-IMT in univariate analysis were assessed by regression analysis. Left femoral IMT and MBPS were independently associated with increased A-IMT. In the regression model, each 5-mmHg elevation in MBPS increased the risk of increased A-IMT by 34.2%. The cutoff value of MBPS obtained by the ROC curve analysis was 32 mmHg for the prediction of increased A-IMT (sensitivity 76.3%, specificity 63.5%). The area under the curve was 0.784 (95% CI 0.720–0.847, p < 0.001).


Abdominal A-IMT increased at a significant rate in patients with HT. An independent association was found between MBPS and A-IMT, which can both be easily detected by ABPM and B-mode USG. The high MBPS level was considered to be a simple and inexpensive method for detecting subclinical target organ damage. A-IMT measurement should also be a part of abdominal USG, which is a routine examination in HT patients.


Aortic intima–media thickness Morning blood pressure surge 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests and sources of funding.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from patients for being included in the study.


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2018

Authors and Affiliations

  • Ayse Selcan Koc
    • 1
  • Ferıde Fatma Gorgulu
    • 1
  • Yurdaer Donmez
    • 2
  • Yahya Kemal Icen
    • 2
  1. 1.Department of RadiologyUniversity of Health Sciences, Adana Health Practice and Research CenterAdanaTurkey
  2. 2.Department of CardiologyUniversity of Health Sciences, Adana Health Practice and Research CenterAdanaTurkey

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