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 (mm³/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.