Normal systolic BP maintenance prevents plaque progression, even with low CV risk burden
Click Here to Manage Email Alerts
Among adults without established CVD, a systolic BP of 118 mm Hg or less maintained over time can attenuate coronary atherosclerosis progression, according to an analysis using coronary CT angiography.
“Serial assessment of coronary plaques using IVUS has contributed to understanding the pathophysiology of coronary artery disease,” Hyuk‐Jae Chang, MD, PhD, of the division of cardiology at Severance Cardiovascular Hospital, Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center and Yonsei University College of Medicine in Seoul, South Korea, and colleagues wrote in Clinical Cardiology. “However, it is hard to perform IVUS in a low-CV risk population because of its invasiveness and high cost. Recently improved technology in coronary CTA has allowed noninvasive evaluation and comprehension of coronary atherosclerosis. Therefore, this study aimed to evaluate the association of normal systolic BP maintenance with coronary plaque volume changes in adults without baseline CVD using the quantitative measurement by serial coronary CTA.”
Chang and colleagues analyzed data from 95 adults (mean age, 57 years; 40 men) without baseline CVD who underwent serial coronary CTA as part of the PARADIGM study, a prospective, observational registry for evaluating associations of clinical factors with changes in coronary atherosclerosis across seven countries. Researchers stratified participants by systolic BP level: a systolic BP of less than 120 mm Hg (n = 40) and a systolic BP of greater than 120 mm Hg (n = 55) and assessed annualized plaque volume changes in both groups. Mean follow-up was 3.5 years.
“Data on the history of coronary atherosclerosis in subjects without established CVD has been scarce because the performance of coronary CTA in this population is not yet justified despite the outstanding advances in coronary CTA technique,” the researchers wrote. “It was possible for the current study to evaluate this issue because PARADIGM is, to the best of our knowledge, the largest serial coronary CTA registry to date.”
Researchers found that participants with an elevated systolic BP had higher annualized total plaque volume change compared with those with a normal systolic BP (0 vs. 4.1 mm3/year; P < .001). Baseline total plaque volume (beta = 0.1) and levels of maintained systolic BP (beta = 0.23) and follow‐up HDL (beta = 0.28) were associated with annualized total plaque volume change (P for all < .05).
Researchers found that the optimal cutoff of maintained systolic BP for predicting plaque progression was 118.5 mm Hg, with a sensitivity of 78.2% and a specificity of 62.5% (area under curve = 0.7; 95% CI, 0.59-0.81; P < .05).
Maintained systolic BP of at least 118.5 mm Hg independently influenced risk for coronary plaque progression, with an OR of 4.03 (95% CI, 1.51-10.75), as did baseline total plaque volume, with an OR of 1.03 (95% CI, 1.01-1.06).
“Despite the characteristics of participants in the current study being completely different from those of the SPRINT study, these results showed the significance of normal maintained systolic BP even in conditions of low CV risk burden,” the researchers wrote. “In addition, these findings could be substantial evidence to support the reinforced American College of Cardiology/American Heart Association guideline for hypertension.”
The researchers noted that a large proportion of the overall PARADIGM registry included participants who identified as East Asians; in this substudy, all participants were East Asian.
“Hence, this might limit the generalizability of the findings,” the researchers wrote.
Collapse
Read more about
Click Here to Manage Email Alerts