Relationship between hypertension and non-obstructive coronary artery disease in chronic coronary syndrome (the NORIC registry)

Abstract

Background The burden of non-obstructive coronary artery disease (CAD) in the society is high, and there is currently limited evidence-based recommendation for risk stratification and treatment. Previous studies have demonstrated an association between increasing extent of non-obstructive CAD and cardiovascular events. Whether hypertension, a modifiable cardiovascular risk factor, is associated with extensive non-obstructive CAD in patients with symptomatic chronic coronary syndrome (CCS) remains unclear. Methods We included 1138 patients (mean age 62±11 years, 48% women) with symptomatic CCS and non-obstructive CAD (1–49% lumen diameter reduction) by coronary computed tomography angiography (CCTA) from the Norwegian Registry for Invasive Cardiology (NORIC). The extent of non-obstructive CAD was assessed as coronary artery segment involvement score (SIS), and extensive non-obstructive CAD was adjudicated when SIS >4. Hypertension was defined as known hypertension or use of antihypertensive medication. Results Hypertension was found in 45% of patients. Hypertensive patients were older, with a higher SIS, calcium score, and prevalence of comorbidities and statin therapy compared to the normotensive (all p<0.05). There was no difference in the prevalence of hypertension between sexes. Univariable analysis revealed a significant association between hypertension and non-obstructive CAD. In multivariable analysis, hypertension remained associated with extensive non-obstructive CAD, independent of sex, age, smoking, diabetes, statin treatment, obesity and calcium score (OR 1.85, 95% CI [1.22–2.80], p = 0.004). Conclusion In symptomatic CCS, hypertension was associated with extensive non-obstructive CAD by CCTA. Whether hypertension may be a new treatment target in symptomatic non-obstructive CAD needs to be explored in future studies. Clinical trial registration ClinicalTrials.gov: Identifier NCT 04009421.

Role Of Multislice Computed Tomography in Assessment of Coronary Atherosclerosis

“…In agreement with our results in a study on 1138 patients, 45% of the individuals were hypertensive and had higher calcium scores and comorbidities than normotensive patients. Thus, there is a marked association between the Onset of Hypertension and the incidence of Cardiovascular Diseases (15).…”

Compositional plaque progression in women and men with non-obstructive coronary artery disease

“…Plaque volume (mm 3 ), vessel volume (mm 3 ), and vessel length (mm) were obtained for all coronary artery segments. Plaque distribution was scored as segment involvement score (SIS), and extensive coronary artery disease defined as SIS > 4 [17] . In addition, visually identifiable coronary artery lesions were co-registered using anatomical landmarks such as distance from the ostium and subdivisions of the coronary vessels.…”

INOCA y angina microvascular en la mujer hipertensa

“…Systemic arterial hypertension (SAH) is the most prevalent factor in 45 to 59% of cases. 4,5 The development of secondary left ventricular hypertrophy (LVH) is associated with symptomatic myocardial ischemia even without coronary lesions. 6 Bairey Merz et al 3 reported that SAH can also influence myocardial perfusion through vasomotor alterations, endothelial dysfunction (ED), atherosclerosis, and poor vascular autoregulation capacity due to remodeling or hardening of the coronary microvasculature, which together with the deregulation of the aortic-ventricular coupling and subendocardial hypoperfusion contribute to CMD.…”