Abstract
The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines.
Highlights
Hypertension (HTN) is one of the most important cardiovascular risk factors, and accounts for approximately half of all cardiovascular disease (CVD) events worldwide [1]
As the correlation between thoracic aorta calcification (TAC) and the different levels of hypertension classified in the revised HTN guidelines has not been fully established, the objective of this study was to investigate the correlations between the TAC burden assessed by multi-detector computed tomography (MDCT), blood pressure metrics (including systolic blood pressure, diastolic blood pressure, and pulse pressure (SBP, DBP, and PP, respectively)), and other cardiovascular risk factors in a large cohort of Asian patients with hypertension, according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines [2]
The enrolled subjects were divided into four study groups according to their blood pressure measurements and the 2017 ACC/AHA HTN guidelines: (1) normal blood pressure (NBP), defined as SBP less than 120 mmHg and DBP less than 80 mmHg; (2) preclinical stage of HTN as elevated blood pressure (EBP), defined as SBP between 120 and 129 mmHg and DBP less than 80 mmHg; (3) stage 1 hypertension (S1 HTN), defined as SBP between 130 and 139 mmHg or DBP between 80 and 89 mmHg; and (4) stage 2
Summary
Hypertension (HTN) is one of the most important cardiovascular risk factors, and accounts for approximately half of all cardiovascular disease (CVD) events worldwide [1]. Several population-based epidemiological studies have revealed a high degree of association between hypertension and the TAC score, assessed using computed tomography (CT) the Caucasian populations [4,9,10,11]. The findings of previous studies have suggested that Asian populations are more susceptible to hypertension-related CVD at early stages of the disease relative to other ethnic groups [12,13] In this regard, we speculated that the effect of blood pressure on great arterial damage, as manifested by aortic calcification in the pre-clinical stage and defined as elevated blood pressure not reaching the guideline-recommended HTN threshold [13,14], likely imitates HTN-related CVD in the Asian population. As the correlation between TAC and the different levels of hypertension classified in the revised HTN guidelines has not been fully established, the objective of this study was to investigate the correlations between the TAC burden assessed by multi-detector computed tomography (MDCT) (such as volume and density of calcification), blood pressure metrics (including systolic blood pressure, diastolic blood pressure, and pulse pressure (SBP, DBP, and PP, respectively)), and other cardiovascular risk factors in a large cohort of Asian patients with hypertension, according to the 2017 ACC/AHA guidelines [2]
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