Coronary Artery Calcium Score for Personalization of Antihypertensive Therapy: A Pooled Cohort Analysis.
Coronary Artery Calcium Score for Personalization of Antihypertensive Therapy: A Pooled Cohort Analysis.
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DOI：
10.1161/hypertensionaha.120.16689
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Arora P
中科院分区：
文献类型：
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作者：
Parcha V;Malla G;Kalra R;Li P;Pandey A;Nasir K;Arora G;Arora P
补充数字内容可在文本中找到。2017年美国心脏病学会/美国心脏协会高血压（BP）指南建议对动脉粥样硬化性心血管疾病进行风险评估，以告知血压升高或低风险I期高血压成人的高血压治疗。使用冠状动脉钙化（CAC）评分指导高血压治疗尚未得到充分评价。无心血管疾病的参与者来自动脉粥样硬化的多种族研究、年轻人冠状动脉风险发展和杰克逊心脏研究。采用多变量校正的考克斯回归分析，根据CAC状态（CAC-0或CAC>0）和BP治疗组评估心血管事件（心力衰竭、卒中、冠心病）的风险。还估计了预防单一心血管事件所需的10年治疗时间。这项研究包括6461名参与者（中位年龄53岁; 53.3%女性; 32.3%黑人参与者）。在平均8.5年的随访中，发生了347起心血管事件。与血压正常者相比，血压升高/低危I期高血压和CAC>0的患者发生心血管事件的风险更高（风险比，2.4 [95% CI，1.7-3.4]）和高风险I/II期高血压（BP，140-160/80-100 mm Hg），CAC>0（风险比，2.9 [95% CI，2.1-4.0]）。在不同种族亚组和个体研究结局中，相似的模式也很明显。在CAC-0患者中，血压升高/低风险I期高血压患者需要治疗10年的人数为160人，高风险I期或II期高血压患者需要治疗10年的人数为44人（血压，140-160/80-100 mm Hg）。在CAC>0的患者中，10年需要治疗的人数分别为36人和22人。CAC评分的使用可以指导高血压治疗和预防方法的启动，以降低当前指南不推荐治疗的个体的心血管风险。
Supplemental Digital Content is available in the text. The 2017 American College of Cardiology/American Heart Association high blood pressure (BP) guidelines recommend risk assessment of atherosclerotic cardiovascular disease to inform hypertension treatment in adults with elevated BP or low-risk stage I hypertension. The use of coronary artery calcium (CAC) score to guide hypertension therapy has not been adequately evaluated. Participants free of cardiovascular disease were pooled from Multi-Ethnic Study of Atherosclerosis, Coronary Artery Risk Development in Young Adults, and Jackson Heart Study. The risk for incident cardiovascular events (heart failure, stroke, coronary heart disease), by CAC status (CAC-0 or CAC>0) and BP treatment group was assessed using multivariable-adjusted Cox regression. The 10-year number needed to treat to prevent a single cardiovascular event was also estimated. This study included 6461 participants (median age 53 years; 53.3% women; 32.3% Black participants). Over a median follow-up of 8.5 years, 347 incident cardiovascular events occurred. Compared with those with normal BP, the risk of incident cardiovascular event was higher among those with elevated BP/low-risk stage I hypertension and CAC>0 (hazard ratio, 2.4 [95% CI, 1.7–3.4]) and high-risk stage I/stage II hypertension (BP, 140–160/80–100 mm Hg) with CAC>0 (hazard ratio, 2.9 [95% CI, 2.1–4.0]). A similar pattern was evident across racial subgroups and for individual study outcomes. Among those with CAC-0, the 10-year number needed to treat was 160 for elevated BP/low-risk stage I hypertension and 44 for high-risk stage I or stage II hypertension (BP, 140–160/80–100 mm Hg). Among those with CAC>0, the 10-year number needed to treat was 36 and 22, respectively. Utilization of the CAC score may guide the initiation of hypertension therapy and preventive approaches to personalize cardiovascular risk reduction among individuals where the current guidelines do not recommend treatment.