The relationship of hypertension to coronary atherosclerosis and cardiac events in patients with coronary CT angiography

Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent and severity of coronary atherosclerosis in coronary computed tomography angiography as well as cardiac events risk. Of 17181 patients enrolled in the CONFIRM registry who underwent ≥64-detector row coronary computed tomography angiography, we identified 14803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and no-hypertension patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (non-obstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score 1–5, >5) was also assessed. HT patients less commonly had no coronary atherosclerosis and more commonly had non-obstructive as well as one, two, and three vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (Hazard ratios 1.4, 95% confidence intervals 1.0–1.9). Compared to no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events than the no-hypertension group. Similar trends were observed with respect to extent of coronary artery disease. Compared to no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events.