Prognostic value of coronary computed tomographic angiography in patients with arterial hypertension

Patients with arterial hypertension have a high risk of developing coronary artery disease (CAD), but noninvasive diagnosis of CAD remains difficult. We assessed the ability of coronary CT angiography (CCTA) to detect CAD and to predict subsequent cardiac events in hypertensive patients. We compared 906 hypertensive patients without known CAD undergoing CCTA with 906 matched normotensive patients. Besides calcium score and the degree of the most severe stenosis, the number of coronary segments with atherosclerotic changes was recorded. The primary endpoint was the occurrence of hard cardiac events defined as all cause death, nonfatal myocardial infarction or unstable angina requiring hospitalization. During a median follow-up of 29 months, there were 17 hard cardiac events in the hypertensive group and 13 events in the control group. The best predictor of events in hypertensive patients was the degree of the most severe stenosis (C-index 0.705, P < 0.001, both corrected for clinical risk). The annual event rate was 0.3% for patients without obstructive CAD and 1.5% for patients with obstructive CAD. In hypertensive patients without known CAD, coronary CT angiography allows for the identification of patients at high risk for incident cardiac events.