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Coronary artery calcium scoring in patients with hypertension

Abstract

Coronary artery calcium (CAC) is increased by high blood pressure (BP), predicts new-onset hypertension, and is a powerful predictor of atherosclerotic cardiovascular disease events in patients with and without hypertension. Unlike other diseases (e.g., hypercholesterolemia), the clinical use of CAC scoring to personalize the treatment of high BP has not received much attention and therefore remains less well defined. Herein, we provide an updated review of studies investigating the relationship between CAC and BP. Finally, we propose a clinical algorithm to incorporate CAC into hypertension management, with a focus on its potential value in tailoring the timing of medication therapy and in helping to personalize BP goals.

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Fig. 1: Use of CAC results to help determine when to initiate anti-hypertensive medicines.
Fig. 2: Use of CAC results to help determine blood pressure targets.

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References

  1. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol 2018;71:e127–248.

    Article  Google Scholar 

  2. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA. 2017;317:165–82.

    Article  Google Scholar 

  3. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–528.

    Article  Google Scholar 

  4. Lawes CM, Hoorn SV, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513–8.

    Article  Google Scholar 

  5. ASCVD Risk Estimator Plus. http://tools.acc.org/ASCVD-Risk-Estimator. Accessed 5 July 2020.

  6. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N. Engl J Med. 2015;373:2103–16.

    Article  Google Scholar 

  7. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. J Am Coll Cardiol 2019;73:e285–350.

    Article  Google Scholar 

  8. Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC, Sperling LS, Virani SS, et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2019;73:3153–67.

    Article  Google Scholar 

  9. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary calcium score and cardiovascular risk. J Am Coll Cardiol 2018;72:434–47.

    Article  CAS  Google Scholar 

  10. Polonsky TS, McClelland RL, Jorgensen NW, Bild DE, Burke GL, Guerci AD, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010;303:1610–1616.

    Article  CAS  Google Scholar 

  11. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;74:e177–232.

    Article  Google Scholar 

  12. Budoff MJ, Young R, Burke G, Jeffrey Carr J, Detrano RC, Folsom AR, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018;39:2401–8.

    Article  CAS  Google Scholar 

  13. Mahabadi AA, Möhlenkamp S, Lehmann N, Kälsch H, Dykun I, Pundt N, et al. CAC score improves coronary and CV risk assessment above statin indication by ESC and AHA/ACC primary prevention guidelines. JACC Cardiovasc Imaging. 2017;10:143–53.

    Article  Google Scholar 

  14. Mallikethi-Reddy S, Rubenfire M, Jackson LA, Brook RD. Coronary artery calcium in hypertension: a review. J Am Soc Hypertens 2015;9:993–1000.

    Article  CAS  Google Scholar 

  15. Aladin AI, Al Rifai M, Rasool SH, Dardari Z, Yeboah J, Nasir K, et al. Relation of coronary artery calcium and extra-coronary aortic calcium to incident hypertension (from the multi-ethnic study of atherosclerosis). Am J Cardiol 2018;121:210–6.

    Article  CAS  Google Scholar 

  16. Rahman F, Al Rifai M, Blaha MJ, Nasir K, Budoff MJ, Psaty BM, et al. Relation of diastolic blood pressure and coronary artery calcium to coronary events and outcomes (from the multi-ethnic study of atherosclerosis). Am J Cardiol 2017;120:1797–803.

    Article  CAS  Google Scholar 

  17. Uddin SMI, Mirbolouk M, Kianoush S, Orimoloye OA, Dardari Z, Whelton SP, et al. Role of coronary artery calcium for stratifying cardiovascular risk in adults with hypertension. Hypertension. 2019;73:983–9.

    Article  CAS  Google Scholar 

  18. McEvoy JW, Martin SS, Dardari ZA, Miedema MD, Sandfort V, Yeboah J, et al. Coronary artery calcium to guide a personalized risk-based approach to initiation and intensification of antihypertensive therapy. Circulation. 2017;135:153–65.

    Article  CAS  Google Scholar 

  19. Kang J, Chang Y, Kim S, Sung K-C, Shin H, Ryu S. Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults. Atherosclerosis. 2019;282:188–95.

    Article  CAS  Google Scholar 

  20. Aljizeeri A, Alsaileek A, Al-Mallah MH. Coronary artery calcium score to guide hypertension therapy! Atherosclerosis. 2019;282:162–4.

    Article  CAS  Google Scholar 

  21. Martin SA, Boucher M, Wright JM, Saini V. Mild hypertension in people at low risk. BMJ. 2014;349:g5432.

    Article  Google Scholar 

  22. Viera AJ, Hawes EM. Management of mild hypertension in adults. BMJ. 2016;355:i5719.

    Article  Google Scholar 

  23. Brook RD. The 2017 hypertension guidelines: approaches to mild hypertension and combination therapy. 2018, https://www.acc.org/latest-in-cardiology/articles/2018/08/21/16/f09/the-2017-hypertension-guidelines.

  24. Sheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs FDR, et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension. JAMA Intern Med 2018;178:1626–34.

    Article  Google Scholar 

  25. Muntner P, Whelton PK. Using predicted cardiovascular disease risk in conjunction with blood pressure to guide antihypertensive medication treatment. J Am Coll Cardiol 2017;69:2446–56.

    Article  Google Scholar 

  26. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: ESC/ESH Task Force for the Management of Arterial Hypertension. J Hypertens 2018;36:2284–309.

    Article  CAS  Google Scholar 

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Correspondence to Richard L. Weinberg.

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Weinberg, R.L., Rubenfire, M. & Brook, R.D. Coronary artery calcium scoring in patients with hypertension. J Hum Hypertens 34, 609–616 (2020). https://doi.org/10.1038/s41371-020-0350-4

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