Blood pressure class and carotid artery intima-media thickness in a population at the secondary epidemiological transition

Objectives: Data relating blood pressure (BP) class to subclinical organ damage are infrequently reported in populations with a traditional 'nonwestern' lifestyle. As the relevance of BP stratification to cardiovascular prognosis has not been elucidated in these low-income countries at the second epidemiological transition, we aimed to study the effect of BP class on carotid artery intima-media thickness (IMT) in Flores Island, Indonesia. Methods: A cross-sectional study was performed in 476 inhabitants (men/women) of Flores. BP was classified using the European Society of Hypertension/European Society of Cardiology classification. The primary endpoint was mean carotid-IMT measured by ultrasonography in classes of BP. Covariate analysis was performed adjusting for conventional cardiovascular risk factors. Results: BP ranged from 94 to 250 mmHg systolic and 50 to 125 mmHg diastolic, 35% of the population had 'grade-I hypertension' or higher, 1.7% of the population was short-term treated with antihypertensive therapy. IMT significantly differed for BP classes (P < 0.001). Mean (±SEM) IMT was 587.8 (±9.3) μm, 621.5 (±7.6) μm, 653.6 (±10.5) μm, 717.9 (±14.0) μm, and 750.1 (±21.8) μm for 'optimal', '(high) normal', 'grade-I, grade-II, and grade-III hypertension' classes, respectively. After adjustment for cardiovascular risk factors, similar results were obtained. Conclusion: A strong association was found between BP class and carotid artery IMT in treatment-naive participants of a population with a traditional lifestyle, at the second epidemiological transition. Intriguingly, the increase of IMT was already observed at the 'high normal' BP class. This study may help to prioritize preventive and therapeutic measures to lower BP in countries at the second epidemiological transition.