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Published on: June 2, 2022
Accelerated progression of coronary artery calcification in hypertension but also prehypertension
Nils Lehmann1, Raimund Erbel, Amir A Mahabadi
1aInstitute for Medical Informatics, Biometry & Epidemiology bDepartment of Cardiology cInstitute of Clinical Chemistry and Laboratory Medicine, University Clinic Essen, Essen dDepartment of Cardiology, Krankenhaus Bethanien, Moers, Germany eDepartment of Epidemiology, Boston University, Massachusetts, USA fInstitute of Medical Sociology, University Clinic Düsseldorf, Düsseldorf gAlfried Krupp Hospital Essen, Essen hDiagnosticum, Mülheim iInstitute of Diagnostic and Interventional Radiology, University Witten/Herdecke, Witten, Germany *Nils Lehmann and Raimund Erbel contributed equally to the article.
Insights
Hypertension accelerates coronary artery calcification (CAC) progression, even in prehypertension stages. Early detection and management of elevated blood pressure are crucial for preventing cardiovascular damage.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Public Health
Background:
- Coronary artery calcification (CAC) is a marker of atherosclerosis.
- Hypertension is a known risk factor for cardiovascular disease.
- Understanding the relationship between blood pressure and CAC progression is vital for cardiovascular risk assessment.
Purpose of the Study:
- To investigate the association between hypertension and the progression of coronary artery calcification (CAC).
- To determine if elevated blood pressure, including prehypertension, accelerates CAC progression.
Main Methods:
- Analysis of the population-based Heinz Nixdorf Recall study data from 3481 participants with 5-year follow-up scans.
- Coronary artery calcification (CAC) measured using electron-beam computed tomography.
- Blood pressure staged according to Joint National Committee 7 guidelines; antihypertensive medication use classified participants as stage 2.
- CAC progression classified as slow, expected, or rapid based on a predictive algorithm.
Main Results:
- The frequency of rapid CAC progression increased significantly with higher blood pressure stages.
- Relative risks for rapid CAC progression were elevated across all hypertension stages compared to normotension.
- Even individuals with blood pressure below 140/90 mmHg showed accelerated CAC progression, particularly women.
Conclusions:
- Coronary artery calcification (CAC) progression is accelerated in individuals with prehypertension, indicating early target organ damage.
- Elevated blood pressure, even below traditional hypertension thresholds, is associated with increased CAC progression.
- These findings highlight the importance of managing blood pressure to mitigate cardiovascular risk.
Objective:
To determine the role of hypertension for coronary artery calcification (CAC) progression.
Methods:
The population-based Heinz Nixdorf Recall study recruited 4814 participants from a German urban population in 2000-2003. CAC was measured using electron-beam computed tomography at baseline and after 5 years. The present analyses refer to 3481 participants with repeat scan (coronary heart disease until 5 years excluded, age at baseline 45-74 years, and 53.1% women). Blood pressure (BP), Framingham risk factors, and antihypertensive medication were recorded at baseline. BP was staged according to Joint National Committee 7 guidelines. Participants under antihypertensive medication were classified as stage 2. CAC at 5 years was predicted from baseline using our dedicated, publicly available algorithm. CAC progression was accordingly classified as slow, expected, or rapid.
Results:
Normotension was found in 20.5%, prehypertension in 27.2%, stage 1 hypertension in 15.8%, and stage 2 (ST2) in 36.5%. The frequency of rapid progression increases with BP stage (normotension: 16.7% to ST2: 21.1%, P = 0.004). Risk factor adjusted relative risk [RR (95% confidence interval), reference: normotension] of rapid progression was for prehypertension: 1.22 (0.98;1.51), stage 1: 1.29 (1.01;1.65), and ST2: 1.45 (1.17;1.79). Risk factor adjusted measures of CAC progression per 10 mmHg SBP were already elevated in women with BP below 140/90 mmHg: CAC onset, RR = 1.22 (1.07;1.40), rapid progression, RR = 1.17 (1.05;1.31), 5-year CAC progression, 6.7% (0.5;13.4). In men below 140/90 mmHg, only RR of rapid progression was considerably increased [RR = 1.11 (0.96;1.29)].
Conclusion:
CAC progression, a sign of ongoing target organ damage, is already accelerated in prehypertensive patients, a substantial proportion of our urban population.
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