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J Hypertens. 2016 Nov;34(11):2233-42. doi: 10.1097/HJH.0000000000001080.

Accelerated progression of coronary artery calcification in hypertension but also prehypertension.

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aInstitute for Medical Informatics, Biometry & Epidemiology bDepartment of Cardiology cInstitute of Clinical Chemistry and Laboratory Medicine, University Clinic Essen, Essen dDepartment of Cardiology, Krankenhaus Bethanien, Moers, Germany eDepartment of Epidemiology, Boston University, Massachusetts, USA fInstitute of Medical Sociology, University Clinic Düsseldorf, Düsseldorf gAlfried Krupp Hospital Essen, Essen hDiagnosticum, Mülheim iInstitute of Diagnostic and Interventional Radiology, University Witten/Herdecke, Witten, Germany *Nils Lehmann and Raimund Erbel contributed equally to the article.



To determine the role of hypertension for coronary artery calcification (CAC) progression.


The population-based Heinz Nixdorf Recall study recruited 4814 participants from a German urban population in 2000-2003. CAC was measured using electron-beam computed tomography at baseline and after 5 years. The present analyses refer to 3481 participants with repeat scan (coronary heart disease until 5 years excluded, age at baseline 45-74 years, and 53.1% women). Blood pressure (BP), Framingham risk factors, and antihypertensive medication were recorded at baseline. BP was staged according to Joint National Committee 7 guidelines. Participants under antihypertensive medication were classified as stage 2. CAC at 5 years was predicted from baseline using our dedicated, publicly available algorithm. CAC progression was accordingly classified as slow, expected, or rapid.


Normotension was found in 20.5%, prehypertension in 27.2%, stage 1 hypertension in 15.8%, and stage 2 (ST2) in 36.5%. The frequency of rapid progression increases with BP stage (normotension: 16.7% to ST2: 21.1%, P = 0.004). Risk factor adjusted relative risk [RR (95% confidence interval), reference: normotension] of rapid progression was for prehypertension: 1.22 (0.98;1.51), stage 1: 1.29 (1.01;1.65), and ST2: 1.45 (1.17;1.79). Risk factor adjusted measures of CAC progression per 10 mmHg SBP were already elevated in women with BP below 140/90 mmHg: CAC onset, RR = 1.22 (1.07;1.40), rapid progression, RR = 1.17 (1.05;1.31), 5-year CAC progression, 6.7% (0.5;13.4). In men below 140/90 mmHg, only RR of rapid progression was considerably increased [RR = 1.11 (0.96;1.29)].


CAC progression, a sign of ongoing target organ damage, is already accelerated in prehypertensive patients, a substantial proportion of our urban population.

[Indexed for MEDLINE]

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