Pulse Pressure and Other Cardiovascular Risk Factors Associated with Multiple Carotid Plaques in a Rural Chinese Population: A Population-Based Cross-Sectional Study.

Objective: This study aimed to investigate the association between these Blood pressure (BP) components examined in this study, including systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP), with the presence of multiple carotid plaques in a low-income rural Chinese population.

Methods: This population-based cross-sectional study was conducted from April 2014 to January 2015, involving participants from the Tianjin Brain Study. Participants aged 45 years and older with diagnosed carotid plaques were included. Data on demographics, medical history, and lifestyle factors were collected through interviews and existing records. Blood pressure measurements were taken in a quiet room, following the standard procedures recommended by the American Hypertension Association (AHA), and ultrasonographic examinations were performed to identify and quantify carotid plaques. Multivariate logistic regression model was used to explore the association between blood pressure components and multiple plaques. The blood pressure component with a positive univariate analysis was included in different models, each adjusted for age, sex, body mass index (BMI), and the ratio of high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C).

Results: The study found that 41.8% of participants had multiple carotid plaques, with a higher prevalence in men compared to women. Multivariate logistic regression analysis revealed that each 1-mmHg increase in systolic BP (SBP) was associated with a 0.9% increase in the prevalence of multiple carotid plaques (OR = 1.009; 95% CI 1.004-1.014; P < 0.001). Each 1-mmHg increase in pulse pressure (PP) was associated with a 1.2% increase (OR = 1.012; 95% CI 1.006-1.018; P < 0.001), and each 1-mmHg increase in mean arterial pressure (MAP) was associated with a 1.1% increase (OR = 1.011; 95% CI 1.003-1.019; P = 0.005). Participants with a history of hypertension had a significantly higher prevalence of multiple carotid plaques compared to normotensive individuals. Notably, grade 2 hypertension showed a significant association with multiple carotid plaques (OR = 1.554; 95% CI 1.135-2.127; P = 0.006). In addition, male sex, older age, and low BMI were all associated with a higher risk of multiple carotid plaques (P all< 0.05).

Conclusion: This study provides critical evidence on the relationship between BP components and multiple carotid plaques, with significant implications for patients, physicians, and society. By prioritizing BP management, particularly focusing on PP, which demonstrates the strongest association with carotid plaques, as well as targeting higher-risk populations such as males, older individuals, and those with low BMI, preventive measures against carotid atherosclerosis can be enhanced. This will ultimately contribute to better cardiovascular health outcomes and reduce the societal burden of stroke and related diseases.