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Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines

Ya-Ting Jan1,2,3,4, Pei-Shan Tsai1,2,3,4, Chris T Longenecker5

  • 1Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.

Diagnostics (Basel, Switzerland)
|July 2, 2021
PubMed

Insights

The 2017 hypertension guidelines reveal thoracic aortic calcification (TAC) risk increases even with elevated blood pressure, not yet classified as hypertension. This finding highlights the importance of early blood pressure management for cardiovascular health.

Area of Science:

  • Cardiology
  • Radiology
  • Preventive Medicine

Background:

  • The 2017 ACC/AHA hypertension guidelines lowered thresholds for hypertension (HTN) to enable earlier cardiovascular disease (CVD) prevention.
  • Thoracic aortic calcification (TAC) is a novel marker for vascular aging and aortic degeneration, but its association with HTN stages under the 2017 guidelines is not well-defined.

Purpose of the Study:

  • To investigate the relationship between different stages of hypertension, as defined by the 2017 ACC/AHA guidelines, and thoracic aortic calcification (TAC) in asymptomatic individuals.
  • To identify independent risk factors for TAC and establish predictive blood pressure cutoffs for TAC presence.

Main Methods:

  • 3022 asymptomatic individuals were categorized into normal blood pressure (NBP), elevated blood pressure (EBP), stage 1 (S1) HTN, and stage 2 (S2) HTN based on 2017 ACC/AHA guidelines.
  • Coronary artery calcification and TAC metrics (Agatston score, plaque volume, mean density) were assessed using multi-detector computed tomography.
  • Multivariate logistic regression was used to determine independent risk factors for TAC.

Main Results:

  • A significant, graded increase in TAC metrics was observed from elevated blood pressure (EBP) through stages 1 and 2 HTN compared to normal blood pressure (NBP).
  • Independent risk factors for higher TAC included older age (>50 years), S1/S2 HTN, diabetes, and chronic kidney disease (<60 mL/min/1.73 m²).
  • Optimal blood pressure cutoffs for TAC presence (excluding known CVD/medication) were 121 mmHg systolic, 74 mmHg diastolic, and 45 mmHg pulse pressure.

Conclusions:

  • Thoracic aortic calcification (TAC) risk begins at the elevated blood pressure stage, preceding formal hypertension diagnosis under the 2017 ACC/AHA guidelines.
  • The findings underscore the significance of managing elevated blood pressure for preventing aortic calcification and related CVD.
  • Early identification and management of elevated blood pressure are crucial for mitigating TAC risk.

Keywords:
hypertensionmulti-detector computed tomographythoracic aorta calcification

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