Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography

Rine Nakanishi; Lohendran Baskaran; Heidi Gransar; Matthew J Budoff; Stephan Achenbach; Mouaz Al-Mallah; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin J W Chow; Augustin DeLago; Martin Hadamitzky; Joerg Hausleiter; Ricardo Cury; Gudrun Feuchtner; Yong-Jin Kim; Jonathon Leipsic; Philipp A Kaufmann; Erica Maffei; Gilbert Raff; Leslee J Shaw; Todd C Villines; Allison Dunning; Hugo Marques; Gianluca Pontone; Daniele Andreini; Ronen Rubinshtein; Jeroen Bax; Erica Jones; Niree Hindoyan; Millie Gomez; Fay Y Lin; James K Min; Daniel S Berman

doi:10.1161/HYPERTENSIONAHA.117.09402

Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography

Hypertension. 2017 Aug;70(2):293-299. doi: 10.1161/HYPERTENSIONAHA.117.09402. Epub 2017 Jun 12.

Authors

Rine Nakanishi¹, Lohendran Baskaran¹, Heidi Gransar¹, Matthew J Budoff¹, Stephan Achenbach¹, Mouaz Al-Mallah¹, Filippo Cademartiri¹, Tracy Q Callister¹, Hyuk-Jae Chang¹, Kavitha Chinnaiyan¹, Benjamin J W Chow¹, Augustin DeLago¹, Martin Hadamitzky¹, Joerg Hausleiter¹, Ricardo Cury¹, Gudrun Feuchtner¹, Yong-Jin Kim¹, Jonathon Leipsic¹, Philipp A Kaufmann¹, Erica Maffei¹, Gilbert Raff¹, Leslee J Shaw¹, Todd C Villines¹, Allison Dunning¹, Hugo Marques¹, Gianluca Pontone¹, Daniele Andreini¹, Ronen Rubinshtein¹, Jeroen Bax¹, Erica Jones¹, Niree Hindoyan¹, Millie Gomez¹, Fay Y Lin¹, James K Min¹, Daniel S Berman²

Affiliations

¹ From the Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, Torrance, CA (R.N., M.J.B.); Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (R.N., H.G., D.S.B.); Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine (L.B., E.J., N.H., M.G., F.Y.L., J.K.M.); Department of Medicine, University of Erlangen, Germany (S.A.); King Saudbin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia (M.A.-M.); Department of Radiology, Montreal Heart Institute, Quebec, Canada (F.C., E.M.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.J.W.C.); Capitol Cardiology Associates, Albany, New York (A.D.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Germany (M.H.); Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Germany (J.H.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.); Department of Radiology, Medical University of Innsbruck, Austria (G.F.); Department of Medicine and Radiology, Seoul National University Hospital, South Korea (Y.-J.K.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Nuclear Cardiology, Cardiovascular Center, University Hospital, Zurich, Switzerland (P.A.K.); Department of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); Duke Clinical Research Institute, Durham, NC (A.D.); UNICA, Cardiac CT and MRI Unit, Hospital da Luz, Lisbon, Portugal (H.M.); Department of Clinical Sciences and Community Health, University of Milan, Italy (G.P., D.A.); Centro Cardiologico Monzino, IRCCS, Italy (G.P., D.A.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (R.R.); and Department of Cardiology, Leiden University Medical Center, HARTZ, The Netherlands (J.B.).
² From the Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, Torrance, CA (R.N., M.J.B.); Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (R.N., H.G., D.S.B.); Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine (L.B., E.J., N.H., M.G., F.Y.L., J.K.M.); Department of Medicine, University of Erlangen, Germany (S.A.); King Saudbin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia (M.A.-M.); Department of Radiology, Montreal Heart Institute, Quebec, Canada (F.C., E.M.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.J.W.C.); Capitol Cardiology Associates, Albany, New York (A.D.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Germany (M.H.); Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Germany (J.H.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.); Department of Radiology, Medical University of Innsbruck, Austria (G.F.); Department of Medicine and Radiology, Seoul National University Hospital, South Korea (Y.-J.K.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Nuclear Cardiology, Cardiovascular Center, University Hospital, Zurich, Switzerland (P.A.K.); Department of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); Duke Clinical Research Institute, Durham, NC (A.D.); UNICA, Cardiac CT and MRI Unit, Hospital da Luz, Lisbon, Portugal (H.M.); Department of Clinical Sciences and Community Health, University of Milan, Italy (G.P., D.A.); Centro Cardiologico Monzino, IRCCS, Italy (G.P., D.A.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (R.R.); and Department of Cardiology, Leiden University Medical Center, HARTZ, The Netherlands (J.B.). Bermand@cshs.org.

Abstract

Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events.

Keywords: angiography; atherosclerosis; coronary artery disease; hypertension; risk factors.

Publication types

Multicenter Study

MeSH terms

Aged
Computed Tomography Angiography* / adverse effects
Computed Tomography Angiography* / methods
Computed Tomography Angiography* / statistics & numerical data
Coronary Angiography* / adverse effects
Coronary Angiography* / methods
Coronary Angiography* / statistics & numerical data
Coronary Artery Disease* / complications
Coronary Artery Disease* / epidemiology
Female
Humans
Hypertension* / complications
Hypertension* / epidemiology
International Cooperation
Male
Middle Aged
Myocardial Ischemia* / epidemiology
Myocardial Ischemia* / prevention & control
Outcome and Process Assessment, Health Care
Prognosis
Proportional Hazards Models
Prospective Studies
Registries / statistics & numerical data
Risk Assessment / methods
Risk Factors
Severity of Illness Index

Grants and funding

M01 RR000425/RR/NCRR NIH HHS/United States