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Prediction of incident hypertension with the coronary artery calcium score based on the 2017 ACC/AHA high blood pressure guidelines

Hypertension Research volume 43, pages 1293–1300 (2020)Cite this article

Abstract

Coronary artery calcification (CAC), a marker of atherosclerosis, is predictive of incident hypertension based on the 2017 ACC/AHA high blood pressure guidelines. We performed a large cohort study to investigate whether incident hypertension could be predicted from CAC measurements as a measure of atherosclerosis, even when updated hypertension criteria are applied. A total of 27,918 male subjects who underwent CAC examination during a health screening program between 2011 and 2017 were enrolled. According to the 2017 ACC/AHA guidelines, hypertension was defined as 130/80 mmHg. Cox proportional hazard analysis was used to assess the risk of incident hypertension according to CAC categories (CAC = 0, 1–10, 11–100, >100). After exclusion, 14,335 subjects were included (mean age 40.0 [5.7] years). During the follow-up period (median 3.63 years), 3050 subjects (21.3%) developed hypertension. The subjects in the highest CAC category showed an increased risk of hypertension compared with the lowest CAC category, as confirmed by multivariate adjusted hazard ratios of 1.27 (95% confidence interval [CI], 1.01–1.60; P < 0.001). The increased risk of developing hypertension was consistent after adjustments were made for several confounding factors. The CAC score, a marker of atherosclerosis, is positively associated with incident hypertension according to the updated 2017 ACC/AHA guidelines.

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References

  1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.

    Article  Google Scholar 

  2. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383:1899–911.

    Article  Google Scholar 

  3. Shen L, Ma H, Xiang MX, Wang JA. Meta-analysis of cohort studies of baseline prehypertension and risk of coronary heart disease. Am J Cardiol. 2013;112:266–71.

    Article  Google Scholar 

  4. Gaziano TA, Bitton A, Anand S, Weinstein MC. The global cost of nonoptimal blood pressure. J Hypertens. 2009;27:1472–7.

    Article  CAS  Google Scholar 

  5. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114:1761–91.

    Article  Google Scholar 

  6. Carr JJ, Jacobs DR Jr., Terry JG, Shay CM, Sidney S, Liu K, et al. Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death. JAMA Cardiol. 2017;2:391–9.

    Article  Google Scholar 

  7. Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol. 1998;31:126–33.

    Article  CAS  Google Scholar 

  8. Budoff MJ, Diamond GA, Raggi P, Arad Y, Guerci AD, Callister TQ, et al. Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation. 2002;105:1791–6.

    Article  Google Scholar 

  9. Grossman C, Shemesh J, Dovrish Z, Morag NK, Segev S, Grossman E. Coronary artery calcification is associated with the development of hypertension. Am J Hypertens. 2013;26:13–9.

    Article  CAS  Google Scholar 

  10. 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 

  11. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, 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: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2018;71:e127–248.

    Article  Google Scholar 

  12. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama. 2003;289:2560–72.

    Article  CAS  Google Scholar 

  13. Vaduganathan M, Pareek M, Qamar A, Pandey A, Olsen MH, Bhatt DL. Baseline blood pressure, the 2017 ACC/AHA high blood pressure guidelines, and long-term cardiovascular risk in SPRINT. Am J Med. 2018;131:956–60.

    Article  Google Scholar 

  14. Lee JY, Ryu S, Cheong E, Sung KC. Association of physical activity and inflammation with all-cause, cardiovascular-related, and cancer-related mortality. Mayo Clin Proc. 2016;91:1706–16.

    Article  Google Scholar 

  15. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.

    Article  Google Scholar 

  16. Oh JY, Yang YJ, Kim BS, Kang JH. Validity and reliability of Korean version of International Physical Activity Questionnaire (IPAQ) short form. J Korean Acad Fam Med. 2007;28:532–41.

    Google Scholar 

  17. Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, et al. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2009;53:345–52.

    Article  CAS  Google Scholar 

  18. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr., Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.

    Article  CAS  Google Scholar 

  19. Mackey RH, Venkitachalam L, Sutton-Tyrrell K. Calcifications, arterial stiffness and atherosclerosis. In: Safar ME, Frohlich ED, editors. Atherosclerosis, large arteries and cardiovascular risk. Basel: Karger; 2007. pp. 234–44.

  20. McLeod AL, Uren NG, Wilkinson IB, Webb DJ, Maxwell SR, Northridge DB, et al. Non-invasive measures of pulse wave velocity correlate with coronary arterial plaque load in humans. J Hypertens. 2004;22:363–8.

    Article  CAS  Google Scholar 

  21. Sawabe M, Takahashi R, Matsushita S, Ozawa T, Arai T, Hamamatsu A, et al. Aortic pulse wave velocity and the degree of atherosclerosis in the elderly: a pathological study based on 304 autopsy cases. Atherosclerosis. 2005;179:345–51.

    Article  CAS  Google Scholar 

  22. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  Google Scholar 

  23. Tikhonoff V, Casiglia E. Measuring regional arterial stiffness in patients with peripheral artery disease: innovative technology. Hypertens Res. 2013;36:191–3.

    Article  Google Scholar 

  24. Al-Mallah MH, Nasir K, Katz R, Takasu J, Lima JA, Bluemke DA, et al. Thoracic aortic distensibility and thoracic aortic calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol. 2010;106:575–80.

    Article  CAS  Google Scholar 

  25. Post WS, Larson MG, Levy D. Impact of left ventricular structure on the incidence of hypertension. The Framingham Heart Study. Circulation. 1994;90:179–85.

    Article  CAS  Google Scholar 

  26. Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, et al. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. J Am Coll Cardiol. 1996;27:277–84.

    Article  CAS  Google Scholar 

  27. DeFina LF, Radford NB, Barlow CE, Willis BL, Leonard D, Haskell WL, et al. Association of all-cause and cardiovascular mortality with high levels of physical Activity and concurrent coronary artery calcification. JAMA Cardiol. 2019;4:174–81.

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the efforts of the health screening group at Kangbuk Samsung Hospital, Korea.

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Funded by author’s own resources.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Ki-Chul Sung

  2. Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Mi-Yeon Lee

  3. Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea

    Jang-Young Kim

  4. Department of Internal Medicine, JB lab and clinic, Seoul, Republic of Korea

    Jeong Bae Park

  5. Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, Catholic University, Seoul, Republic of Korea

    Eun Joo Cho

  6. Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia

    Alberto Avolio

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Contributions

KS contributed to the hypothesis, wrote the methods and contributed to the discussion. ML analyzed the data. JK contributed to the discussion. JP contributed to the discussion. EC contributed to the discussion. AA contributed to the discussion and introduction. KS is the guarantor for the paper.

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Correspondence to Ki-Chul Sung or Eun Joo Cho.

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Sung, KC., Lee, MY., Kim, JY. et al. Prediction of incident hypertension with the coronary artery calcium score based on the 2017 ACC/AHA high blood pressure guidelines. Hypertens Res 43, 1293–1300 (2020). https://doi.org/10.1038/s41440-020-0526-x

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