Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease

Abstract

Background Atherosclerosis‐related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease. Hypothesis Normal SBPmaintain is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease. Methods We analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow‐up. All participants were divided into two groups of normal SBPmaintain (follow‐up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow‐up SBP ≥ 120 mm Hg). Annualized PVC was defined as PVC divided by the interscan period. Results Compared to participants with normal SBPmaintain, those with ≥elevated SBPmaintain had higher annualized total PVC (mm3/year) (0.0 [0.0–2.2] vs. 4.1 [0.0–13.0]; p < .001). Baseline total plaque volume (β = .10) and the levels of SBPmaintain (β = .23) and follow‐up high‐density lipoprotein cholesterol (β = −0.28) were associated with annualized total PVC (all p < .05). The optimal cutoff of SBPmaintain for predicting plaque progression was 118.5 mm Hg (sensitivity: 78.2%, specificity: 62.5%; area under curve: 0.700; 95% confidence interval [CI]: 0.59–0.81; p < .05). SBPmaintain ≥ 118.5 mm Hg (odds ratio [OR]: 4.03; 95% CI: 1.51–10.75) and baseline total plaque volume (OR: 1.03; 95% CI: 1.01–1.06) independently influenced coronary plaque progression (all p < .05). Conclusion Normal SBPmaintain is substantial to attenuate coronary atherosclerosis progression in conditions without established CV disease.

Assessment of Normal Systolic Blood Pressure Maintenance with the Risk of Coronary Artery Calcification Progression in Asymptomatic Metabolically Healthy Korean Adults with Normal Weight, Overweight, and Obesity

“…Fourth, data on consecutive changes in the clinical variables were unavailable during follow-up periods because of the observational nature of the study. In the present study, normal SBP maintain was defined based on a followup SBP < 120 mm Hg without considering antihypertensive medication in participants with newly developed hypertension [41]. Some participants with normal SBP maintain were misclassified into those with ≥elevated SBP maintain because of white-coat effect and it could attenuate the effect ≥elevated SBP maintain on the risk of CAC progression.…”