Key result
In patients with symptomatic chronic coronary syndrome, hypertension was independently associated with an 81% increased odds of having extensive non-obstructive coronary artery disease (OR 1.85).
Why the study?
Whether hypertension is associated with extensive non-obstructive CAD in patients with symptomatic chronic coronary syndrome remains unclear.
Is hypertension associated with extensive non-obstructive CAD in patients with symptomatic chronic coronary syndrome?
Cross-Sectional (n=1,138)
No
Is hypertension associated with extensive non-obstructive CAD in patients with symptomatic chronic coronary syndrome?
In patients with symptomatic chronic coronary syndrome, hypertension is independently associated with more extensive non-obstructive coronary artery disease as assessed by CCTA.
Highlights hypertension as a key risk marker for non-obstructive CAD burden in symptomatic patients.
BACKGROUND: The burden of non-obstructive coronary artery disease (CAD) in the society is high, and there is currently limited evidence-based recommendation for risk stratification and treatment. Previous studies have demonstrated an association between increasing extent of non-obstructive CAD and cardiovascular events. Whether hypertension, a modifiable cardiovascular risk factor, is associated with extensive non-obstructive CAD in patients with symptomatic chronic coronary syndrome (CCS) remains unclear. METHODS: We included 1138 patients (mean age 62±11 years, 48% women) with symptomatic CCS and non-obstructive CAD (1-49% lumen diameter reduction) by coronary computed tomography angiography (CCTA) from the Norwegian Registry for Invasive Cardiology (NORIC). The extent of non-obstructive CAD was assessed as coronary artery segment involvement score (SIS), and extensive non-obstructive CAD was adjudicated when SIS >4. Hypertension was defined as known hypertension or use of antihypertensive medication. RESULTS: Hypertension was found in 45% of patients. Hypertensive patients were older, with a higher SIS, calcium score, and prevalence of comorbidities and statin therapy compared to the normotensive (all p<0.05). There was no difference in the prevalence of hypertension between sexes. Univariable analysis revealed a significant association between hypertension and non-obstructive CAD. In multivariable analysis, hypertension remained associated with extensive non-obstructive CAD, independent of sex, age, smoking, diabetes, statin treatment, obesity and calcium score (OR 1.85, 95% CI [1.22-2.80], p = 0.004). CONCLUSION: In symptomatic CCS, hypertension was associated with extensive non-obstructive CAD by CCTA. Whether hypertension may be a new treatment target in symptomatic non-obstructive CAD needs to be explored in future studies. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: Identifier NCT04009421.
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Berge et al. (2022) conducted a cross-sectional in Symptomatic chronic coronary syndrome with non-obstructive coronary artery disease (n=1,138). Hypertension vs. No hypertension was evaluated on Extensive non-obstructive coronary artery disease (segment involvement score >4) (OR 1.85, 95% CI 1.22-2.80, p=0.004). In patients with symptomatic chronic coronary syndrome, hypertension was independently associated with an 81% increased odds of having extensive non-obstructive coronary artery disease (OR 1.85).
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