2017년 ACC/AHA 가이드라인에 따른 1단계 고혈압과 무증상 관상동맥 죽상경화증과의 관련성

Abstract

Background The evidence of relationship between stage 1 hypertension defined by ACC/AHA 2017 guideline and subclinical coronary atherosclerosis on coronary computed tomography angiography (CCTA) is lacking. Method A total of 4666 individuals with CCTA result as a health checkup were enrolled in this study. Hypertension category was defined according to ACC/AHA 2017 guideline. The presence of coronary plaque and its characteristics, coronary artery calcium (CAC) score, and significant stenosis defined as luminal narrowing > 50% were assessed. Result The mean age was 52.6 ± 7.3 years and 3311 (71.0%) were men. The patients were classified into 4 groups; normal, 2395 (51.3%); elevated, 467 (10.0%); stage 1 hypertension, 1139 (24.4%); and stage 2 hypertension, 665 (14.2%). The incidence of CT findings including high CAC score, all types of coronary plaque, significant stenosis were tended to be higher as increasing BP groups. When compared to normal group after multivariate adjustment, stage 1 and 2 hypertensions were significantly associated with the presence of atherosclerotic plaque (adjusted OR, 1.38 [1.17 – 1.63]; P = 0.0001 and adjusted OR, 1.66 [1.36 – 2.03]; P < 0.0001) especially in non-calcified and mixed plaque. Significant stenosis was found to be significantly higher only in stage 2 hypertension, but not in stage 1 hypertension. Elevated BP group was not associated with any positive CCTA findings. Systolic BP and diastolic BP in continuous level showed linear relationship with the risk of coronary plaque. Conclusion The stage 1 hypertension defined by ACC/AHA 2019 guideline (systolic BP 130 – 139 mmHg, diastolic BP 80 – 89 mmHg) was independently associated with subclinical coronary atherosclerosis.