title: Grade-response relationship between blood pressure and severity of coronary atherosclerosis in asymptomatic adults: assessment with coronary CT angiography.
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.
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Gyeonggido, 436-707, Korea.
authors.forename: Tae Seong
authors.initials: TS
authors.lastname: Im
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Chun
authors.forename: Min Su
authors.initials: MS
authors.lastname: Lee
authors.forename: Theodor
authors.initials: T
authors.lastname: Adla
authors.forename: Jeong A
authors.initials: JA
authors.lastname: Kim
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D001794:Blood Pressure; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index