Hypertensive patients are more likely to develop coronary artery disease on computed tomography coronary angiography

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Systemic hypertension (HTN) is the strongest cause for morbidity and mortality all over the world for its association with target organ damage including coronary artery disease (CAD). It creates a great challenge in medical field because it is often asymptomatic. CT coronary angiography (CTCA) being a non-invasive tool can be used to assess the presence of CAD successfully. In this study we aimed to identify the association between HTN and CAD. Methods The individual electronic health records of 566 consecutive patients who underwent CTCA between July and November 2020, were retrospectively reviewed. TAVI studies and graft assessment studies were excluded. A total of 485 patient (mean age 60.4) reports were analysed. All risk factors were recorded including smoking (23%), hyperlipidaemia (37%), positive family history (22%), systemic hypertension (51%), diabetes mellitus (30%) and male gender (50%). Referral criteria were also recorded for statistical analyses. Ethnicity, cardiac and past medical history were also recorded. Results Of the 170 patients with moderate-severe CAD, 127 (74.7%) had hypertension, and of the 100 patients with severe CAD, 78 (78%) had hypertension. Univariate analysis for comparison of patients with none (n = 222), mild (n = 93), moderate (n = 70) and severe (n = 100) CAD revealed that hypertension (P < 0.001), diabetes (P = 0.007), gender (P < 0.001), dyslipidaemia (P < 0.001) and smoking (P = 0.005), were all significantly associated with the presence of CAD on CTCA. However, multivariate analysis using a multiple logistic regression model, confirmed a significant association between hypertension and CAD (OR = 1.26, P < 0.001). SHAP-values for model interpretation revealed that hypertension has the strongest impact on CAD presence on CTCA. Conclusions Hypertension is the strongest independent predictor for the presence of CAD detected on CTCA, amongst diabetes, gender, dyslipidaemia, positive family history and smoking. These results suggest that hypertension and the other risk factors associated with CAD, should form the main parameters on consideration for CTCA referral. Further studies relating our results to the CTCA reports of same patients after a longer period of aggressive hypertension treatment, would prove essential in establishing the role of blood pressure management in the progress of angiographic coronary disease.