Abstract
Blood pressure (BP)-lowering treatment should be aimed at achieving intensive BP control. Coronary computed tomography angiography (CCTA) has become more widely available and enables the accurate noninvasive assessment of coronary artery stenosis for screening. The presence and severity of coronary artery disease (CAD) in patients who achieved intensive BP control at the time of CCTA were compared to those in patients without hypertension (HTN). Nine hundred eighty-five consecutive subjects who were clinically suspected of having CAD or who had at least one cardiac risk factor underwent CCTA. The patients were divided into four groups: patients without HTN (non-HTN group), hypertensive patients who underwent intensive BP lowering (intensive group, <130/80 mmHg), patients who underwent standard BP lowering (standard group, 130–139/80–89 mmHg) and patients with uncontrolled BP (uncontrolled group, >140/90 mmHg). Interestingly, %CAD in the Intensive group was significantly higher than that in patients without HTN. The Intensive group was older and had a higher body mass index, more significantly stenosed coronary vessels, lower levels of high-density lipoprotein cholesterol in the blood, and higher rates of dyslipidemia, diabetes, and anti-dyslipidemia and anti-diabetic medication use than the non-HTN group. The presence of CAD in the Intensive group was independently associated with age, male and smoking, whereas the presence of CAD in the non-HTN group was associated with age, male and family history. Finally, predictors of the number of VDs in the non-HTN and intensive BP-lowering groups were age, male, DL, and intensive BP lowering. In conclusion, these results suggest that hypertensive patients need more rigorous management of other coronary risk factors, despite receiving intensive BP-lowering treatment.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ikeda N, Inoue M, Iso H, Ikeda S, Satoh T, Noda M, et al. Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment. PLoS Med. 2012;9:e1001160.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the manageme nt of hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.
Satoh A, Arima H, Ohkubo T, Nishi N, Okuda N, Ae R, et al. NIPPON DATA2010 Research Group. Associations of socioeconomic status with prevalence, awareness, treatment, and control of hypertension in a general Japanese population: NIPPON DATA2010. J Hypertens. 2017;35:401–8.
Rumberger JA, Sheedy PF 3rd, Breen JF, Schwartz RS. Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram. Effect of patient’s sex on diagnosis. Circulation. 1995;91:1363–7.
Nitta K, Akiba T, Suzuki K, Uchida K, Ogawa T, Majima K, et al. Assessment of coronary artery calcification in hemodialysis patients using multi-detector spiral CT scan. Hypertens Res. 2004;27:527–33.
Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, et al. Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol. 2004;43:842–7.
Ueda Y, Shiga Y, Idemoto Y, Tashiro K, Motozato K, Koyoshi R, et al. Association between the presence or severity of coronary artery disease and pericardial fat, paracardial fat, epicardial fat, visceral fat, and subcutaneous fat as assessed by multi-detector row computed tomography. Int Heart J. 2018;59:695–704.
Mitsutake R, Niimura H, Miura S, Zhang B, Iwata A, Nishikawa H, et al. Clinical significance of the coronary calcification score by multidetector row computed tomography for the evaluation of coronary stenosis in Japanese patients. Circ J. 2006;70:1122–7.
Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983;51:606.
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.
Kinoshita M, Yokote K, Arai H, Iida M, Ishigaki Y, Ishibashi S, et al. The Japan Atherosclerosis Society. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017. J Atheroscler Thromb. 2018;25:846–984.
American Diabetes Association. Screening for type 2 diabetes. Diabetes Care. 2004;27:S11–14.
The Examination committee of criteria for diagnosis of metabolic syndrome. Definition and criteria for diagnosis of metabolic syndrome. J Jpn Soc Int Med. 2005;94:794–809.
Kim HL, Jin KN, Seo JB, Choi YH, Chung WY, Kim SH, et al. The association of brachial-ankle pulse wave velocity with coronary artery disease evaluated by coronary computed tomography angiography. PLoS One. 2015;10:e0123164.
Arima H, Tanizaki Y, Kiyohara Y, Tsuchihashi T, Kato I, Kubo M, et al. Validity of the JNC VI recommendations for the management of hypertension in a general population of Japanese elderly: the Hisayama study. Arch Intern Med. 2003;163:361–6.
Ueda K, Omae T, Hasuo Y, Kiyohara Y, Fujii I, Wada J, et al. Prognosis and outcome of elderly hypertensives in a Japanese community: results from a long-term prospective study. J Hypertens. 1988;6:991–7.
Nicholls SJ, Tuzcu EM, Sipahi I, Grasso AW, Schoenhagen P, Hu T, et al. Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA. 2007;297:499–508.
Fukuda Y, Miura S, Tsuchiya Y, Inoue-Sumi Y, Kubota K, Takamiya Y, et al. Lower frequency of non-target lesion intervention in post-successful percutaneous coronary intervention patients with an LDL to HDL cholesterol ratio below 1.5. Int J Cardiol. 2011;149:120–2.
Mitsutake R, Miura S, Shiga Y, Uehara Y, Saku K. Association between hypertension and coronary artery disease as assessed by coronary computed tomography. J Clin Hypertens (Greenwich). 2011;13:198–204.
Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations. Circulation. 1999;100:1481–92.
Naito R, Miyauchi K. Coronary artery disease and Type 2 diabetes mellitus. Int Heart J. 2017;58:475–80.
Ropers D, Rixe J, Anders K, Küttner A, Baum U, Bautz W, et al. Usefulness of multidetector row computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol. 2006;97:343–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tsukihashi, Y., Shiga, Y., Suematsu, Y. et al. Presence and severity of coronary artery disease in patients who achieved intensive blood pressure reduction at the time of coronary computed tomography angiography. Hypertens Res 44, 206–214 (2021). https://doi.org/10.1038/s41440-020-00545-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41440-020-00545-6
Keywords
This article is cited by
-
May need more comprehensive approach to residual risks in well controlled hypertensive patients
Hypertension Research (2021)