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Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines

by 1,2,3,4,†, 1,2,3,4,†, 5, 6,7,8, 2,3,4, 1,3,9, 10,11,12, 3,9, 3,9,10, 1,*,‡, 13, 3,9, 3,9, 3,4,14,*,‡ and 15,16
1
Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
2
Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan
3
Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
4
Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
5
University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
6
Division of Endocrine and metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
7
Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
8
School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
9
Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
10
Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei 100, Taiwan
11
Health Evaluation Center, MacKay Memorial Hospital, Taipei 104, Taiwan
12
Department of Medical Technology, Yuanpei University of Science and Technology, Hsin-Chu City 306, Taiwan
13
Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
14
Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 104, Taiwan
15
Imaging Program, Lawson Health Research Institute, London, ON N6C 2R5, Canada
16
Department of Medical Biophysics, University of Western Ontario, London, ON N6A 3K7, Canada
*
Authors to whom correspondence should be addressed.
Y.-T.J. and P.-S.T. contributed equally to this work.
C.-Y.C. and T.-H.W. contributed equally to this work.
Academic Editors: Gino Seravalle Seravalle and Michael Henein
Diagnostics 2021, 11(6), 1027; https://doi.org/10.3390/diagnostics11061027
Received: 26 March 2021 / Revised: 6 May 2021 / Accepted: 31 May 2021 / Published: 3 June 2021
(This article belongs to the Section Pathology and Molecular Diagnostics)
The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines. View Full-Text
Keywords: hypertension; multi-detector computed tomography; thoracic aorta calcification hypertension; multi-detector computed tomography; thoracic aorta calcification
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MDPI and ACS Style

Jan, Y.-T.; Tsai, P.-S.; Longenecker, C.T.; Lin, D.-C.; Yun, C.-H.; Sung, K.-T.; Liu, C.-C.; Kuo, J.-Y.; Hung, C.-L.; Wu, T.-H.; Lin, J.-L.; Hou, C.J.-Y.; Tsai, C.-T.; Chien, C.-Y.; So, A. Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines. Diagnostics 2021, 11, 1027. https://doi.org/10.3390/diagnostics11061027

AMA Style

Jan Y-T, Tsai P-S, Longenecker CT, Lin D-C, Yun C-H, Sung K-T, Liu C-C, Kuo J-Y, Hung C-L, Wu T-H, Lin J-L, Hou CJ-Y, Tsai C-T, Chien C-Y, So A. Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines. Diagnostics. 2021; 11(6):1027. https://doi.org/10.3390/diagnostics11061027

Chicago/Turabian Style

Jan, Ya-Ting, Pei-Shan Tsai, Chris T. Longenecker, Dao-Chen Lin, Chun-Ho Yun, Kuo-Tzu Sung, Chuan-Chuan Liu, Jen-Yuan Kuo, Chung-Lieh Hung, Tung-Hsin Wu, Jiun-Lu Lin, Charles J.-Y. Hou, Cheng-Ting Tsai, Chen-Yen Chien, and Aaron So. 2021. "Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines" Diagnostics 11, no. 6: 1027. https://doi.org/10.3390/diagnostics11061027

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