Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of Antihypertensive Therapy
Authors' conclusion
Combined CAC imaging and assessment of global ASCVD risk has the potential to guide personalized SBP goals (eg, choosing a traditional goal of 140 or a more intensive goal of 120 mm Hg), particularly among adults with an estimated ASCVD risk of 5% to 15% and prehypertension or mild hypertension.
Study context
- Population
- Multi-Ethnic Study of Atherosclerosis (MESA) participants with systolic blood pressure (SBP) 120–179 mm Hg642 composite events
- Participants
- 3,733 participants
- Exposure
- Coronary artery calcium (CAC) 1–100 and CAC >100 vs CAC=0, within SBP and atherosclerotic cardiovascular disease (ASCVD) risk strata
- Outcome
- Composite of:
- Incident ASCVD
- HF
- Follow-up
- Median 10.2 years
Methodological detailsMESA cohort, multivariable-adjusted, Mean age 65 years
- MESA cohort
- Multivariable-adjusted
- Mean age 65 years
Main finding
As reported in the abstract
Composite ASCVD or HF, ASCVD risk <15% (SBP 120–139 / 140–159 mm Hg)
Each group vs CAC=0Hazard ratio (95% CI)
CAC 1–100SBP 120–139 mm Hg
1.7(1.0–2.6)
CAC 1–100SBP 140–159 mm Hg
2.0(1.1–3.8)
CAC >100SBP 120–139 mm Hg
3.0(1.8–5.0)
CAC >100SBP 140–159 mm Hg
5.7(2.9–11.0)
Observational data: associations, not effects.
Further findings
| Outcome | CAC=0 | CAC 1–100 | CAC >100 | |
|---|---|---|---|---|
| Estimated 10-year NNT for SBP goal 120 mm Hg (ASCVD risk <15%, SBP 120–139 mm Hg) | ||||
| 10-year NNT | 99 | Not reported in the abstract | 24 | CAC 1–100: not reported in the abstract |
Estimated 10-year NNT for SBP goal 120 mm Hg (ASCVD risk <15%, SBP 120–139 mm Hg)
- NNT consistently low and varied less among CAC strata when SBP 160–179 mm Hg or ASCVD risk ≥15%
- Few participants with ASCVD risk <5% had elevated CAC
Original publication
Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of Antihypertensive Therapy. Circulation. Published 23 November 2016. doi:10.
Summarised from the published abstract; every number is checked against it