The predictive role of C-reactive protein in subjects with hypertension and subclinical atherosclerosis

Background: Recent guidelines published by the joint European Society ofHypertension/European Society of Cardiology have suggested the inclusion ofC-reactive protein (CRP) in the standard assessment of cardiovascular risk inhypertensive patients, but few data are available on the role of CRP in patientswith carotid lesions.Methods: We studied 472 patients, 236 with and 236 without hypertension,sex- and age-matched, with and without early stages of atherosclerosis (e.g.those with an asymptomatic intima–media thickness of >0.9 mm), the influenceof all the other traditional cardiovascular risk factors (e.g. older age, malesex, obesity, diabetes, smoking habit, family history of coronary artery disease,dyslipidaemia) and of high-sensitivity CRP levels on cerebrovascular andcardiovascular events in a 5-year follow up.Results: At the end of follow up, patients with hypertension had more eventsthan those without (25% vs 17%, P < 0.05). Proportional hazard analysisrevealed in the group of patients without hypertension the presence of baselinecarotid lesions (P = 0.02) as predictor of events. In patients with hypertension,the presence of baseline carotid lesions (P = 0.04) and elevated CRPlevels (P = 0.02) predicted clinical events. Patients with hypertension alsoshowed a significant relationship between clinical events and quintiles of CRPlevels (P < 0.01).Conclusion: Beyond the utility of high-sensitivity CRP levels in the predictionof early and late stages of atherosclerosis and subsequently on its associationwith clinical events, the therapeutic implications of these results remain to beevaluated by further studies