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To investigate the association between increased left ventricular mass and the intima-media thickening of carotid arteries in hypertensive patients and the simultaneous involvement of the heart and the conductance vessels by the hypertensive process.Because no data are available concerning the ultrasonographic characteristics of large arteries in athletes with physiological increases in left ventricular mass, we measured the intima-media thickness (IMT) of the common carotid artery (CCA) in 14 normotensive subjects (group I, aged 22 ± 4 years), in 14 borderline hypertensives (group II, aged 24 ± 6 years) and in 14 Japanese wrestling players (group III, aged 23 ± 4 years). The IMT of the posterior wall of the CCA was measured at 5, 10 and 20 mm caudally to the bifurcation and the measurements were averaged. Left ventricular diameters and thicknesses of the interventricular septum and posterior wall were obtained from two-dimensionally guided M-mode tracings and measured according to the Penn convention. Left ventricular mass was calculated by the formula of Devereux. Left ventricular filling was measured by a pulsed Doppler technique.Both systolic and diastolic blood pressure values were significantly higher in group II (145 ±7/91 ±5mmHg) than they were in group I (116±11/75±5mmHg) and in group III (120±8/78±6mmHg). In athletes and hypertensives both the left ventricular mass index and the IMT of the CCA were significantly greater than they were in control subjects (80±12g/m2 and 0.45 ±0.05 mm in group I; 106±15g/m2 and 0.57 ±0.08 mm in group II; and 122±17g/m2 and 0.55±0.05mm in group III). The mitral early: late peak flow velocity ratio was significantly lower in group II (1.9 ±0.58) than it was in the other two groups (2.3±0.66 in group I and 2.6±0.64 in group III).The results of our study suggest that both hypertension and physical training can induce parallel changes in cardiac and in arterial walls, and that physiological left ventricular hypertrophy in athletes is accompanied by a normal diastolic filling pattern in contrast to the pathological pattern found in hypertensives. Further investigation is required to explore possible differences in carotid structure and function between these two conditions.