Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease

BACKGROUND: Atherosclerosis‐related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBP(maintain)) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease. HYPOTHESIS: Normal SBP(maintain) is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease. METHODS: We analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow‐up. All participants were divided into two groups of normal SBP(maintain) (follow‐up SBP < 120 mm Hg) and ≥elevated SBP(maintain) (follow‐up SBP ≥ 120 mm Hg). Annualized PVC was defined as PVC divided by the interscan period. RESULTS: Compared to participants with normal SBP(maintain), those with ≥elevated SBP(maintain) had higher annualized total PVC (mm(3)/year) (0.0 [0.0–2.2] vs. 4.1 [0.0–13.0]; p < .001). Baseline total plaque volume (β = .10) and the levels of SBP(maintain) (β = .23) and follow‐up high‐density lipoprotein cholesterol (β = −0.28) were associated with annualized total PVC (all p < .05). The optimal cutoff of SBP(maintain) for predicting plaque progression was 118.5 mm Hg (sensitivity: 78.2%, specificity: 62.5%; area under curve: 0.700; 95% confidence interval [CI]: 0.59–0.81; p < .05). SBP(maintain) ≥ 118.5 mm Hg (odds ratio [OR]: 4.03; 95% CI: 1.51–10.75) and baseline total plaque volume (OR: 1.03; 95% CI: 1.01–1.06) independently influenced coronary plaque progression (all p < .05). CONCLUSION: Normal SBP(maintain) is substantial to attenuate coronary atherosclerosis progression in conditions without established CV disease.