Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry

Abstract

Objectives To assess the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk. Design Retrospective cohort study with a mean follow-up of 3.3 years. Setting Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed. Participants 10 754 asymptomatic Korean adults (51.5 +/- 8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBPmaintain (<120 mmHg) and >= elevated SBPmaintain (>= 120 mmHg) at the time of follow-up CAC scan. Main outcome measures CAC progression was defined as a difference of >= 2.5 between the square roots (root) of the baseline and follow-up coronary artery calcium score (CACS) (Delta root transformed CACS). Annualised Delta root transformed CACS was defined as Delta root transformed CACS divided by the interscan period. Results Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, p<0.001) during a mean follow-up of 3.3 years. Normal SBPmaintain was inversely associated with an annualised Delta root transformed CACS (beta: -0.18, 95% CI: -0.25 to -0.12, p<0.001) in non-diabetics, but not in diabetics (beta: -0.07, 95% CI: -0.31 to 0.19, p=0.631). After consecutive adjustments of age, sex, hypertension, dyslipidaemia, obesity, current smoking and baseline CACS, normal SBPmaintain showed a lower risk of CAC progression than >= elevated SBPmaintain in non-diabetics; however, this association was not observed in patients with diabetes. Conclusions Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.