title: Subclinical coronary atherosclerosis predicts cardiovascular risk in different stages of hypertension: result of the Heinz Nixdorf Recall Study.
abstract: Prehypertension is a frequent condition and has been demonstrated to increase cardiovascular risk. However, the association with coronary atherosclerosis as part of target organ damage is not well understood. We investigated the cross-sectional relationship and longitudinal outcome between blood pressure categories and coronary artery calcification (CAC), quantified by electron beam computed tomography, in 4181 participants from the population-based Heinz Nixdorf Recall Study cohort. At baseline, we observed a continuous increase in calcium scores with increasing blood pressure categories. During a median follow-up period of 7.18 years, 115 primary end points (2.8%; fatal and nonfatal myocardial infarction) and 152 secondary end points (3.6%; stroke and coronary revascularization) occurred. We observed a continuous increase in age- and risk factor-adjusted secondary endpoints (hazard ratios [95% CI]) with increasing blood pressure categories (referent: normotension) in men: prehypertension, 1.80 (0.53-6.13); stage 1 hypertension, 2.27 (0.66-7.81); and stage 2 hypertension, 4.10 (1.27-13.24) and in women: prehypertension, 1.13 (0.34-3.74); stage 1 hypertension, 2.14 (0.67-6.85); and stage 2 hypertension, 3.33 (1.24-8.90), respectively, but not in primary endpoints. Cumulative event rates were determined by blood pressure categories and the CAC. In prehypertension, the adjusted hazard ratios for all of the events were, for CAC 1 to 99, 2.05 (0.80-5.23; P=0.13); 100 to 399, 3.12 (1.10-8.85; P=0.03); and ≥400, 7.72 (2.67-22.27; P=0.0002). Risk of myocardial infarction and stroke in hypertension but also in prehypertension depends on the degree of CAC. This marker of target-organ damage might be included, when lifestyle modification and pharmacotherapeutic effects in prehypertensive individuals are tested to avoid exposure to risk and increase benefit.
authors: Department of Cardiology, University Clinic Essen, Essen, Germany. erbel@uk-essen.de
authors: Raimund
authors: R
authors: Erbel
authors: Nils
authors: N
authors: Lehmann
authors: Stefan
authors: S
authors: Möhlenkamp
authors: Sofia
authors: S
authors: Churzidse
authors: Marcus
authors: M
authors: Bauer
authors: Hagen
authors: H
authors: Kälsch
authors: Axel
authors: A
authors: Schmermund
authors: Susanne
authors: S
authors: Moebus
authors: Andreas
authors: A
authors: Stang
authors: Ulla
authors: U
authors: Roggenbuck
authors: Martina
authors: M
authors: Bröcker-Preuss
authors: Nico
authors: N
authors: Dragano
authors: Christian
authors: C
authors: Weimar
authors: Johannes
authors: J
authors: Siegrist
authors: Karl-Heinz
authors: KH
authors: Jöckel
mesh_terms: D000368:Aged; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011237:Predictive Value of Tests; D058246:Prehypertension / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D011795:Surveys and Questionnaires