Effect of systolic blood pressure status on coronary inflammation and high-risk plaque characteristics

Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus (T2DM). It remains unclear whether systolic blood pressure (SBP) status of hypertension is related to coronary inflammation and plaques in T2DM.

To evaluate whether SBP variability (SBPV) and levels of hypertension are related to coronary inflammation and plaques in T2DM patients using coronary computed tomography angiography (CCTA).

This retrospective study involved 881 T2DM patients with CCTA images, including 668 hypertension and 213 normotension patients. Hypertension patients were subgroup based on SBP status: (1) SBPV: Low (< 8.96 mmHg) and high (≥ 8.96 mmHg) groups; and (2) SBP levels: Controlled (< 140 mmHg) and uncontrolled (≥ 140 mmHg) groups. Pericoronary adipose tissue (PCAT) attenuation, high-risk plaques (HRPs) and obstructive stenosis (OS) were evaluated by CCTA. Propensity score matching was utilized to compare these CCTA findings for these groups. The impact of SBPV and SBP levels of hypertension on these CCTA findings in T2DM patients were evaluated by multivariate logistic regression and multivariable linear regression.

PCAT attenuation of the left anterior descending artery (LAD), any low attenuation plaque (LAP), any spotty calcification (SC), any positive remodeling (PR), and OS had significant differences between the hypertension group and the normotension group, as well as between the high SBPV or uncontrolled SBP group and the low SBPV or controlled SBP group (all P < 0.05). Hypertension was independently positively correlated with LAD-PCAT attenuation (β = 1.815, P = 0.010), LAP (OR = 1.612, P = 0.019), SC (OR = 1.665, P = 0.013), PR (OR = 1.549, P = 0.033), and OS (OR = 1.928, P = 0.036) in all T2DM patients. Additionally, high SBPV and uncontrolled SBP were independently positively correlated with LAD-PCAT attenuation (high SBPV: β = 1.673, P = 0.048; uncontrolled SBP: β = 2.370, P = 0.004) and PR (high SBPV: OR = 1.903, P = 0.048; uncontrolled SBP: OR = 2.230, P = 0.013) in T2DM patients with hypertension.

Inadequately controlled hypertension, including high SBPV and/or uncontrolled SBP levels, may be related to increased coronary artery inflammation, HRPs, and OS in T2DM, leading to increased cardiovascular risk. Achieving both low SBPV and controlled SBP levels simultaneously, especially in individuals with T2DM and hypertension, warrants clinical attention.