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Independent association of high blood pressure and aortic atherosclerosis: A population-based study
Y Agmon1, B K Khandheria, I Meissner
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Insights
High blood pressure is linked to aortic atherosclerosis. This includes complex plaque buildup, highlighting the importance of blood pressure management for stroke prevention.
Area of Science:
- Cardiovascular research
- Public health
Background:
- Atherosclerosis of the thoracic aorta is a known risk factor for stroke.
- Hypertension is a major risk factor for stroke, but its link to aortic atherosclerosis in the general population was unclear.
Purpose of the Study:
- To determine the association between hypertension and aortic atherosclerosis in a general population sample.
- To investigate if blood pressure is associated with complex aortic atherosclerosis.
Main Methods:
- Transesophageal echocardiography on 581 adults aged 45+ from Olmsted County, MN.
- Blood pressure assessed via office measurements and 24-hour ambulatory monitoring.
- Multiple logistic regression used to analyze associations, adjusting for age and smoking.
Main Results:
- Age and smoking were independently associated with any and complex aortic atherosclerosis.
- Systolic and pulse pressure, but not diastolic, were associated with aortic atherosclerosis.
- Higher ambulatory systolic blood pressure and hypertension treatment correlated with increased odds of complex aortic atherosclerosis.
Conclusions:
- Hypertension is independently associated with aortic atherosclerosis.
- High blood pressure is linked to more complex forms of aortic atherosclerosis.
Background:
Atherosclerosis of the thoracic aorta is associated with stroke. The association between hypertension, a major risk factor for stroke, and aortic atherosclerosis has not been determined in the general population.
Methods And Results:
Transesophageal echocardiography was performed in 581 subjects, a random sample of the Olmsted County (Minnesota) population aged >/=45 years participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. Blood pressure was assessed by multiple office measurements and 24-hour ambulatory blood pressure monitoring. The association between blood pressure variables and aortic atherosclerosis was evaluated by multiple logistic regression, adjusting for other associated variables. Among subjects with atherosclerosis, blood pressure variables associated with complex aortic atherosclerosis (protruding plaques >/=4 mm thick, mobile debris, or ulceration) were determined. Age and smoking history were independently associated with aortic atherosclerosis of any degree (P:=0.001) and with complex atherosclerosis (P:=0.002), whereas sex, diabetes mellitus, and body mass index were not. Multiple systolic and pulse pressure variables (office and ambulatory), but none of the diastolic blood pressure variables, were associated with atherosclerosis and complex atherosclerosis, adjusting for age and smoking. Among subjects with atherosclerosis, the odds of complex atherosclerosis increased as ambulatory out-of-bed systolic blood pressure increased (odds ratio 1.43 per 10 mm Hg increase, 95% CI 1. 10 to 1.87) and with hypertension treatment, adjusting for age and smoking history.
Conclusions:
High blood pressure is independently associated with aortic atherosclerosis. Among subjects with atherosclerosis, high blood pressure is associated with complex atherosclerosis.
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