Relationship between ambulatory blood pressure and aortic arch atherosclerosis
Shinichi Iwata1, Zhezhen Jin, Joseph E Schwartz
1Department of Medicine, Columbia University, New York, NY 10032, USA.
Insights
Ambulatory blood pressure (BP) monitoring reveals systolic BP variables are linked to aortic arch plaque. Nighttime systolic BP variability independently predicts large plaque, offering insights into its formation.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Radiology
Background:
- Aortic arch atherosclerosis is a key risk factor for ischemic stroke.
- Office blood pressure (BP) is linked to aortic atherosclerosis, but the role of 24-hour ambulatory BP is unclear.
Purpose of the Study:
- To investigate the association between 24-hour ambulatory BP and the presence/severity of aortic arch plaque in a community-based cohort.
Main Methods:
- 795 patients from the CABL study underwent 24-hour ambulatory BP monitoring (ABPM).
- Aortic arch plaque was assessed using 2D transthoracic echocardiography via a suprasternal window.
Main Results:
- Systolic ABPM variables (mean BP and variability) correlated with plaque presence and large plaque (≥4 mm).
- Diastolic BP variables showed no association with aortic atherosclerosis.
- Nighttime systolic BP variability independently predicted large plaque (OR 1.39, P<0.05) after adjustments.
Conclusions:
- Systolic ABPM variables are significantly associated with aortic arch plaque.
- Nighttime systolic BP variability is an independent predictor of large aortic arch plaque.
- Findings may illuminate mechanisms of plaque formation and progression.
Objective:
Atherosclerotic plaque in the aortic arch is an independent risk factor for ischemic stroke. Although high blood pressure (BP) measured at the doctor's office is known to be associated with aortic atherosclerosis, little is known on the association between 24-h ambulatory BP and aortic arch plaque presence and severity. Our objective was to clarify the association between ambulatory BP variables and aortic arch atherosclerosis in a community-based cohort.
Methods:
The study population consisted of 795 patients (mean age 71 ± 9 years) participating in the Cardiovascular Abnormalities and Brain Lesions (CABL) study who underwent 24-h ambulatory BP monitoring (ABPM). Arch plaque was evaluated by 2D transthoracic echocardiography from a suprasternal window.
Results:
All systolic ABPM variables (24-h/daytime/nighttime mean systolic BP, daytime/nighttime systolic BP variability) were associated with the presence of any plaque and large (≥ 4 mm) plaque, whereas diastolic BP variables were not associated with aortic atherosclerosis. Multiple regression analysis indicated that nighttime systolic BP variability (expressed as the standard deviation of nighttime systolic BP) remained independently associated with large plaque after adjustment for age, sex, cigarette smoking, history of hypertension, diabetes mellitus, hypercholesterolemia, anti-hypertensive medication and nighttime mean systolic BP (odds ratio 1.39 per 1 standard deviation increase, 95% CI 1.00-1.93, P<0.05).
Conclusion:
Systolic ABPM variables are significantly associated with the presence of arch plaque. Nighttime systolic BP variability is independently associated with large arch plaque. These findings may have important implications in gaining further insights into the mechanism of arch plaque formation and progression.
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