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—In the present  study, we examined the relationships among carotid blood pressure,  arterial geometry, and wall stress and determined the  impact of hypertension, smoking status, and their interaction on these  relationships. The study involved 679 subjects aged 49 to 82 years: 372  smokers (190 men and 182 women) and 307 nonsmokers (110 men and 197  women). Blood samples were taken to determine total  cholesterol levels. Central pulse pressure was derived from  measured brachial artery pressure with a linear regression equation  from data obtained in a subgroup of 276 subjects that related brachial  and carotid pulse pressures; the latter was measured with applanation  tonometry. Carotid intima-media thickness (IMT), lumen diameter (D),  and stiffness index (SI) were determined with high-resolution B-mode  ultrasound. Mean and pulsatile circumferential stress  (ςC ) was calculated according to the Laplace  relationship. Indexes of arterial geometry and function  were adjusted for age, height, and heart rate. Hypertension (treated  and/or screening blood pressure of &gt;140/90 mm Hg) was  present in 71 nonsmokers and 186 smokers. Nonsmokers and smokers  did not differ in blood pressure and cholesterol levels.  Hypertension and smoking individually and interactively significantly  increased adjusted IMT, D, and SI. The radius-to–wall thickness ratio  (R/IMT) (where R=D/2) and ςC were increased in  hypertensives. SI was correlated with IMT (r =0.56,P &lt;0.001); radius-to–wall thickness ratio was inversely  correlated with central pulse pressure (r =−0.38,P &lt;0.001). Smoking did not influence these  relationships. In conclusion, carotid artery wall remodeling appears to  follow Laplace’s law but is insufficient to prevent an increase in  circumferential stress in hypertensive subjects. Unlike hypertension,  smoking does not influence the lumen-to-wall ratio but has a  significant effect on wall stiffness.

Effects of Blood Pressure, Smoking, and Their Interaction on Carotid Artery Structure and Function