Stages of systemic hypertension and blood pressure as correlates of computed tomography-assessed aortic valve calcium (from the Multi-Ethnic Study of Atherosclerosis)

Abstract

Hypertension has been identified as a risk factor for aortic valve calcium (AVC) but the magnitude of the risk relation with hypertension severity or whether age affects the strength of this risk association has not been studied. The relation of hypertension severity, as defined by Joint National Committee 7 (JNC-7) hypertension stages or blood pressure (BP), to computed tomographically assessed AVC prevalence and severity was examined in 4,274 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) without treated hypertension. Analyses were stratified by age < 65 or ≥ 65 years, were adjusted for common cardiovascular risk factors, and excluded those on antihypertensive medications. In age-stratified adjusted analyses, stage I/II hypertension was associated with prevalent AVC in those <65 but not in those ≥ 65 years of age (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.35 to 3.94, vs 1.33, 0.96 to 1.85, p for interaction = 0.041). Similarly, systolic BP and pulse pressure were more strongly associated with prevalent AVC in those <65 than in those ≥ 65 years of age (OR 1.21, 95% CI 1.08 to 1.35, vs 1.07, 1.01 to 1.14, per 10-mm Hg increase in systolic BP, p for interaction = 0.006; and OR 1.41, 95% CI 1.21 to 1.64, vs 1.14, 1.05 to 1.23, per 10-mm Hg increase in pulse pressure). No associations were found between hypertension stage or BP and AVC severity. In conclusion, stage I/II hypertension and higher systolic BP and pulse pressure were associated with prevalent AVC. These risk associations were strongest in participants < 65 years of age.