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Diastolic blood pressure predicts coronary plaque volume in patients with coronary artery disease
Mohamad Saleh1, Abdulhamied Alfaddagh1, Tarec K Elajami1
1Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
Insights
Lower diastolic blood pressure (DBP) is linked to reduced coronary plaque volume in patients with stable coronary artery disease (CAD). This finding highlights DBP as a key factor in predicting atherosclerosis progression.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Hypertension is a known risk factor for coronary artery disease (CAD).
- The precise relationship between blood pressure levels and the volume of coronary atherosclerotic plaque remains incompletely understood.
- Understanding this link is crucial for managing CAD risk.
Purpose of the Study:
- To investigate the association between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the volume of coronary plaque.
- To determine if specific blood pressure parameters predict plaque burden in patients with established CAD.
Main Methods:
- Coronary computed tomographic angiography (CCTA) was performed on 285 patients with stable CAD receiving statin therapy.
- CCTA was used to quantify the volumes of different plaque types: fatty, fibrous, noncalcified, and calcified.
- Blood pressure measurements (SBP and DBP) were analyzed in relation to plaque volumes.
Main Results:
- Lower diastolic blood pressure (DBP) tertiles were associated with significantly lower volumes of fatty, fibrous, noncalcified, and total coronary plaque compared to the highest DBP tertile.
- Systolic blood pressure (SBP) levels did not show a significant association with coronary plaque volume.
- Higher DBP was identified as an independent predictor of increased plaque volume across all plaque types after multivariate adjustment.
Conclusions:
- Diastolic blood pressure (DBP) is a significant predictor of coronary plaque volume in patients with stable CAD.
- Lower DBP levels, particularly below 68 mmHg, are associated with the least amount of coronary plaque, especially in patients with controlled LDL-C levels (< 80 mg/dL).
- These findings suggest that DBP management may be important for controlling atherosclerosis progression.
Background And Aims:
Hypertension is associated with increased clinical and subclinical coronary artery disease (CAD); however, the relationship between blood pressure and coronary plaque volume is unclear. We examined the effect of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on coronary artery plaque volume.
Methods:
285 subjects with stable CAD on statin therapy underwent coronary computed tomographic angiography to measure volume of fatty, fibrous, noncalcified, calcified and total coronary plaque.
Results:
Mean (SD) age was 63.1 (7.7); mean (SD) LDL-C, 78.7 mg/dL (28.5). Compared to the highest DBP tertile (>76 mmHg), those in the lowest DBP tertile (≤68 mmHg) had lower volumes of fatty: 10.0 vs. 7.7 mm3/mm, (p trend = 0.042), fibrous: 19.6 vs. 13.8 mm3/mm (p trend = 0.011), non-calcified: 29.7 vs. 22.5 mm3/mm (p trend = 0.017) and total plaque: 37.8 vs. 25.1 mm3/mm (p trend = 0.010) whereas there was no relationship with SBP tertiles. Similarly, when examined as a continuous variable, higher DBP was a significant independent predictor of higher plaque volume after multivariate adjustment: for every 1 mmHg increase in DBP, fibrous plaque increased 0.128 mm3/mm (p = 0.022), noncalcified plaque increased 0.176 mm3/mm (p = 0.045), calcified plaque increased 0.096 mm3/mm (p = 0.001) and total plaque increased 0.249 mm3/mm (p = 0.019) whereas SBP ranging from 95 to 154 mmHg did not predict plaque volume.
Conclusions:
Level of DBP predicts coronary plaque with a DBP tertile ≤68 mmHg associated with the least amount of coronary plaque in subjects with LDL-C < 80 mg/dL.
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