Increased burden of coronary artery calcium from elevated blood pressure in low-risk young adults

Abstract Background and aims The relationship between the blood pressure (BP) levels given in the new hypertension guideline by the American College of Cardiology and the American Heart Association (ACC/AHA) and subclinical coronary atherosclerosis in low-risk young adults is unknown. We evaluated the association between the new BP categories and coronary artery calcium (CAC) in low-risk, young and middle-aged adults. Methods We performed a cross-sectional study of 96,166 Koreans who underwent a health examination including cardiac tomography estimation of CAC scores in 2012–2017. BP categories were defined according to the 2017 ACC/AHA guidelines. We used Poisson regression models with robust variance to calculate prevalence ratios (PRs) with 95% confidence intervals (CIs) for prevalent CAC >0. Results Overall, higher BP categories were associated with higher CAC scores in both young (aged 20–39) and middle-aged people (aged 40 years or more). After adjusting for possible confounders, including traditional cardiovascular disease (CVD) risk factors, the multivariable-adjusted PRs (95% CI) for prevalent CAC comparing elevated BP and stage 1 and 2 hypertension to normal BP were 1.27 (1.08–1.49), 1.45 (1.28–1.63), and 2.02 (1.67–2.43), respectively, among those aged 20–39 years and 1.25 (1.15–1.36), 1.29 (1.23–1.359), and 1.46 (1.36–1.57), respectively, among those aged ≥40 years. This association was also evident in those with a 10-year CVD risk of Conclusions Higher BP categories were positively associated with prevalent CAC, and that association began in the elevated BP category, even in a young and low-risk population.