Aim: To evaluate the progression over time of carotid and aortic stiffness and carotid remodeling in hypertensive patients, according to the presence of diabetes mellitus.

Methods: In this prospective observational study, 124 hypertensive patients (32 with Type 2 diabetes –HTDM -, 92 without - HT) were evaluated at Visit 0 (V0) and after a 3.4±1.0-year follow-up (V1). Carotid-femoral pulse wave velocity (PWV), carotid intima-media thickness (cIMT), carotid stiffness (CS) and circumferential wall stress (CWS) were assessed.

Results: In HT BP was unchanged, due to increased antihypertensive drugs (1.3±1 to 1.7±0.8, p=0.001); in HTDM there was a decrease in DBP (82.5±9.1 to 76.2±8.6mmHg, p=0.006) and an improvement of metabolic control (blood glucose 168±45 to 147±31mg/dl; LDL 104±34 to 82±24mg/dl, p≤0.05). At V0 PWV, cIMT and CS were significantly higher in HTDM than in HT (10.9±2.1 vs 8.6±1.5m/s, p<0.0001; 808±125 vs 731±151μm, p=0.01; 7.23±1.25 vs 6.69±1.21m/s, p=0.03 respectively). These variables were unchanged during follow-up. Conversely carotid diameter, which was similar in the two groups at V0, increased in HT (7.47±1.11 to 7.8±0.8mm, p=0.01) but not in HTDM (7.7±0.9 to 7.7±0.8mm, p=0.83) as well as CWS (HT 55±12 to 59±17kPa, p=0.03; HTDM 52±13 to 54±21kPa, p=0.53).

Conclusions: In a cohort of hypertensive patients, followed-up for about 3 years and treated according to routine clinical practice, aortic and carotid stiffness, as well as cIMT did not change over time. Interestingly, in non-diabetic hypertensive patients there was a progression of carotid artery maladaptive remodeling, suggesting lower efficacy of conventional treatment on this vascular feature.