Skip to main content
Erschienen in: The International Journal of Cardiovascular Imaging 2/2014

01.12.2014 | Original Paper

Grade-response relationship between blood pressure and severity of coronary atherosclerosis in asymptomatic adults: assessment with coronary CT angiography

verfasst von: Tae Seong Im, Eun Ju Chun, Min Su Lee, Theodor Adla, Jeong A. Kim, Sang Il Choi

Erschienen in: The International Journal of Cardiovascular Imaging | Sonderheft 2/2014

Einloggen, um Zugang zu erhalten

Abstract

Hypertension is known to be a strong risk factor for coronary atherosclerosis. We aimed to investigate the prevalence, severity, and plaque characteristics of coronary atherosclerosis according to grade of blood pressure (BP) using coronary CT angiography (CCTA) in asymptomatic adults. We enrolled 8,238 asymptomatic subjects who underwent coronary artery calcium scoring (CACS) and CCTA for health screening purposes. Subjects were classified according to JNC 7 guidelines (normal, systolic BP/diastolic BP < 120/80; pre-hypertension [PH], 120–139/80–89; hypertension stage 1 [H1], 140–159/90–99; hypertension stage 2 [H2], >160/100). Isolated systolic hypertension (ISH; systolic BP > 140, diastolic BP < 80) was additionally categorized. With CCTA, the presence of plaques, severity of stenosis, and plaque types were assessed. Using multiple logistic regression analysis, the adjusted odds ratios (AORs) for plaque, obstructive coronary artery disease (CAD) (luminal stenosis ≥50 %), non-calcified plaque (NCP), and CACS > 100 were assessed according to BP grade. After adjustment for clinical risk factors, the risk of subclinical atherosclerosis, NCP, and CACS > 100 gradually increased from PH stage (all P values for trend <0.05), while the risk of obstructive CAD increased from the H1 stage (AORs of H1 and H2: 1.70 and 2.33, respectively). In the ISH group, the AOR of subclinical atherosclerosis (1.64) was higher than in the H1 group (1.55), while the AOR of obstructive CAD (2.58) was higher than in the H2 group (2.33). Therefore, our study strongly suggests that coronary atherosclerosis in asymptomatic adults shows a grade-response relationship according to hypertension grade.
Literatur
1.
Zurück zum Zitat Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Kjeldsen SE, Erdine S, Narkiewicz K, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Cifkova R, Dominiczak A, Fagard R, Heagerty AM, Laurent S, Lindholm LH, Mancia G, Manolis A, Nilsson PM, Redon J, Schmieder RE, Struijker-Boudier HA, Viigimaa M, Filippatos G, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Kiowski W, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O’Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL, The task force for the management of arterial hypertension of the European Society of H, The task force for the management of arterial hypertension of the European Society of C (2007) 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 28(12):1462–1536 Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Kjeldsen SE, Erdine S, Narkiewicz K, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Cifkova R, Dominiczak A, Fagard R, Heagerty AM, Laurent S, Lindholm LH, Mancia G, Manolis A, Nilsson PM, Redon J, Schmieder RE, Struijker-Boudier HA, Viigimaa M, Filippatos G, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Kiowski W, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O’Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL, The task force for the management of arterial hypertension of the European Society of H, The task force for the management of arterial hypertension of the European Society of C (2007) 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 28(12):1462–1536
2.
Zurück zum Zitat Kannel WB (2000) Risk stratification in hypertension: new insights from the Framingham Study. Am J Hypertens 13(1 Pt 2):3S–10SPubMedCrossRef Kannel WB (2000) Risk stratification in hypertension: new insights from the Framingham Study. Am J Hypertens 13(1 Pt 2):3S–10SPubMedCrossRef
3.
Zurück zum Zitat Thomas F, Rudnichi A, Bacri AM, Bean K, Guize L, Benetos A (2001) Cardiovascular mortality in hypertensive men according to presence of associated risk factors. Hypertension 37(5):1256–1261PubMedCrossRef Thomas F, Rudnichi A, Bacri AM, Bean K, Guize L, Benetos A (2001) Cardiovascular mortality in hypertensive men according to presence of associated risk factors. Hypertension 37(5):1256–1261PubMedCrossRef
4.
Zurück zum Zitat Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42(6):1206–1252PubMedCrossRef Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42(6):1206–1252PubMedCrossRef
5.
Zurück zum Zitat Peralta CA, Adeney KL, Shlipak MG, Jacobs D Jr, Duprez D, Bluemke D, Polak J, Psaty B, Kestenbaum BR (2010) Structural and functional vascular alterations and incident hypertension in normotensive adults: the multi-ethnic study of atherosclerosis. Am J Epidemiol 171(1):63–71PubMedCentralPubMedCrossRef Peralta CA, Adeney KL, Shlipak MG, Jacobs D Jr, Duprez D, Bluemke D, Polak J, Psaty B, Kestenbaum BR (2010) Structural and functional vascular alterations and incident hypertension in normotensive adults: the multi-ethnic study of atherosclerosis. Am J Epidemiol 171(1):63–71PubMedCentralPubMedCrossRef
6.
Zurück zum Zitat Erbel R, Mohlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, Dragano N, Gronemeyer D, Seibel R, Kalsch H, Brocker-Preuss M, Mann K, Siegrist J, Jockel KH, Heinz Nixdorf Recall Study Investigative G (2010) Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 56(17):1397–1406CrossRef Erbel R, Mohlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, Dragano N, Gronemeyer D, Seibel R, Kalsch H, Brocker-Preuss M, Mann K, Siegrist J, Jockel KH, Heinz Nixdorf Recall Study Investigative G (2010) Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 56(17):1397–1406CrossRef
7.
Zurück zum Zitat Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ, Kim HK, Choi DJ, Blumenthal RS, Chang HJ (2008) Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 52(5):357–365PubMedCrossRef Choi EK, Choi SI, Rivera JJ, Nasir K, Chang SA, Chun EJ, Kim HK, Choi DJ, Blumenthal RS, Chang HJ (2008) Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 52(5):357–365PubMedCrossRef
8.
Zurück zum Zitat Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (2011) Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol 57(10):1237–1247PubMedCrossRef Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC (2011) Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis. J Am Coll Cardiol 57(10):1237–1247PubMedCrossRef
9.
Zurück zum Zitat Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15(4):827–832PubMedCrossRef Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15(4):827–832PubMedCrossRef
10.
Zurück zum Zitat Chun EJ, Lee W, Choi YH, Koo BK, Choi SI, Jae HJ, Kim HC, So YH, Chung JW, Park JH (2008) Effects of nitroglycerin on the diagnostic accuracy of electrocardiogram-gated coronary computed tomography angiography. J Comput Assist Tomogr 32(1):86–92PubMedCrossRef Chun EJ, Lee W, Choi YH, Koo BK, Choi SI, Jae HJ, Kim HC, So YH, Chung JW, Park JH (2008) Effects of nitroglycerin on the diagnostic accuracy of electrocardiogram-gated coronary computed tomography angiography. J Comput Assist Tomogr 32(1):86–92PubMedCrossRef
11.
Zurück zum Zitat Kim JA, Chun EJ, Lee MS, Kim KJ, Choi SI (2013) Relationship between amount of cigarette smoking and coronary atherosclerosis on coronary CTA in asymptomatic individuals. Int J Cardiovasc Imaging 29(Suppl 1):21–28PubMedCrossRef Kim JA, Chun EJ, Lee MS, Kim KJ, Choi SI (2013) Relationship between amount of cigarette smoking and coronary atherosclerosis on coronary CTA in asymptomatic individuals. Int J Cardiovasc Imaging 29(Suppl 1):21–28PubMedCrossRef
12.
Zurück zum Zitat Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51(4 Suppl):5–40PubMedCrossRef Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51(4 Suppl):5–40PubMedCrossRef
13.
Zurück zum Zitat Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies C (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360(9349):1903–1913PubMedCrossRef Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies C (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360(9349):1903–1913PubMedCrossRef
14.
Zurück zum Zitat Lloyd-Jones DM, Evans JC, Levy D (2005) Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA 294(4):466–472PubMedCrossRef Lloyd-Jones DM, Evans JC, Levy D (2005) Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA 294(4):466–472PubMedCrossRef
15.
Zurück zum Zitat Miura K, Daviglus ML, Dyer AR, Liu K, Garside DB, Stamler J, Greenland P (2001) Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Arch Intern Med 161(12):1501–1508PubMedCrossRef Miura K, Daviglus ML, Dyer AR, Liu K, Garside DB, Stamler J, Greenland P (2001) Relationship of blood pressure to 25-year mortality due to coronary heart disease, cardiovascular diseases, and all causes in young adult men: the Chicago Heart Association Detection Project in Industry. Arch Intern Med 161(12):1501–1508PubMedCrossRef
16.
Zurück zum Zitat Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, Levy D (2001) Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 345(18):1291–1297PubMedCrossRef Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, Levy D (2001) Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 345(18):1291–1297PubMedCrossRef
17.
Zurück zum Zitat Erbel R, Lehmann N, Mohlenkamp S, Churzidse S, Bauer M, Kalsch H, Schmermund A, Moebus S, Stang A, Roggenbuck U, Brocker-Preuss M, Dragano N, Weimar C, Siegrist J, Jockel KH, Heinz Nixdorf Recall Study I (2012) Subclinical coronary atherosclerosis predicts cardiovascular risk in different stages of hypertension: result of the Heinz Nixdorf Recall Study. Hypertension 59(1):44–53CrossRef Erbel R, Lehmann N, Mohlenkamp S, Churzidse S, Bauer M, Kalsch H, Schmermund A, Moebus S, Stang A, Roggenbuck U, Brocker-Preuss M, Dragano N, Weimar C, Siegrist J, Jockel KH, Heinz Nixdorf Recall Study I (2012) Subclinical coronary atherosclerosis predicts cardiovascular risk in different stages of hypertension: result of the Heinz Nixdorf Recall Study. Hypertension 59(1):44–53CrossRef
18.
Zurück zum Zitat Rivera JJ, Nasir K, Cox PR, Choi EK, Yoon Y, Cho I, Chun EJ, Choi SI, Blumenthal RS, Chang HJ (2009) Association of traditional cardiovascular risk factors with coronary plaque sub-types assessed by 64-slice computed tomography angiography in a large cohort of asymptomatic subjects. Atherosclerosis 206(2):451–457PubMedCrossRef Rivera JJ, Nasir K, Cox PR, Choi EK, Yoon Y, Cho I, Chun EJ, Choi SI, Blumenthal RS, Chang HJ (2009) Association of traditional cardiovascular risk factors with coronary plaque sub-types assessed by 64-slice computed tomography angiography in a large cohort of asymptomatic subjects. Atherosclerosis 206(2):451–457PubMedCrossRef
19.
Zurück zum Zitat Hoffmann U, Moselewski F, Nieman K, Jang IK, Ferencik M, Rahman AM, Cury RC, Abbara S, Joneidi-Jafari H, Achenbach S, Brady TJ (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 47(8):1655–1662PubMedCrossRef Hoffmann U, Moselewski F, Nieman K, Jang IK, Ferencik M, Rahman AM, Cury RC, Abbara S, Joneidi-Jafari H, Achenbach S, Brady TJ (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 47(8):1655–1662PubMedCrossRef
20.
Zurück zum Zitat Sipahi I, Tuzcu EM, Schoenhagen P, Wolski KE, Nicholls SJ, Balog C, Crowe TD, Nissen SE (2006) Effects of normal, pre-hypertensive, and hypertensive blood pressure levels on progression of coronary atherosclerosis. J Am Coll Cardiol 48(4):833–838PubMedCrossRef Sipahi I, Tuzcu EM, Schoenhagen P, Wolski KE, Nicholls SJ, Balog C, Crowe TD, Nissen SE (2006) Effects of normal, pre-hypertensive, and hypertensive blood pressure levels on progression of coronary atherosclerosis. J Am Coll Cardiol 48(4):833–838PubMedCrossRef
21.
Zurück zum Zitat Franklin SS, Gustin Wt, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D (1997) Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 96(1):308–315PubMedCrossRef Franklin SS, Gustin Wt, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D (1997) Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 96(1):308–315PubMedCrossRef
22.
Zurück zum Zitat Asmar R (2003) Benefits of blood pressure reduction in elderly patients. J Hypertens Suppl 21(6):S25–S30PubMedCrossRef Asmar R (2003) Benefits of blood pressure reduction in elderly patients. J Hypertens Suppl 21(6):S25–S30PubMedCrossRef
23.
Zurück zum Zitat Kim BG, Park JT, Ahn Y, Kimm K, Shin C (2005) Geographical difference in the prevalence of isolated systolic hypertension in middle-aged men and women in Korea: the Korean Health and Genome Study. J Hum Hypertens 19(11):877–883PubMedCrossRef Kim BG, Park JT, Ahn Y, Kimm K, Shin C (2005) Geographical difference in the prevalence of isolated systolic hypertension in middle-aged men and women in Korea: the Korean Health and Genome Study. J Hum Hypertens 19(11):877–883PubMedCrossRef
Metadaten
Titel
Grade-response relationship between blood pressure and severity of coronary atherosclerosis in asymptomatic adults: assessment with coronary CT angiography
verfasst von
Tae Seong Im
Eun Ju Chun
Min Su Lee
Theodor Adla
Jeong A. Kim
Sang Il Choi
Publikationsdatum
01.12.2014
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe Sonderheft 2/2014
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-014-0522-9

Weitere Artikel der Sonderheft 2/2014

The International Journal of Cardiovascular Imaging 2/2014 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.