Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Effect of systolic blood pressure status on coronary inflammation and high-risk plaque characteristics
Cui-Ping Jiang, Yuan-Kang Liu, Pan-Pan Cheng, Yue Dong, Xiang Wang, Fan-Yu Wu, Yu-Xuan Xia, Peng-Yun Wang, Xiang-Yang Xu
Cui-Ping Jiang, Yuan-Kang Liu, Pan-Pan Cheng, Fan-Yu Wu, Yu-Xuan Xia, Xiang-Yang Xu, Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430060, Hubei Province, China
Yue Dong, Department of Radiology, Taihe Hospital, Hubei University of Medicine, Wuhan 442700, Hubei Province, China
Xiang Wang, Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Peng-Yun Wang, Department of Laboratory Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430060, Hubei Province, China
Co-corresponding authors: Peng-Yun Wang and Xiang-Yang Xu.
Author contributions: Jiang CP was responsible for the conception and design of the study, data analysis, and drafting the initial manuscript; Liu YK, Cheng PP, and Dong Y provided technical support; Wang X, Wu FY, and Xia YX participated in data collection and experiments; Wang PY and Xu XY responsible for the literature review and final revision of the manuscript, ensuring that all authors' comments were integrated, and they contribute equally to this study as co-corresponding authors.
Supported by Natural Science Foundation of Hubei Province, No. 2023AFB848.
Institutional review board statement: The Ethics Review Committee of Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology approved the study protocol, which was carried out in keeping with the Declaration of Helsinki (No. [2024] IEC RYJ002).
Informed consent statement: The committee waived the informed consent requirement because the study was retrospective in nature.
Conflict-of-interest statement: The authors declare no competing interests.
Data sharing statement: Due to the sensitive nature of the data collected in this study, particularly concerning patient privacy and confidentiality, we are unable to share individual participant data.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xiang-Yang Xu, Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 39 Yanhu Avenue, Wuchang District, Wuhan 430060, Hubei Province, China.
1993ly0538@hust.edu.cn
Received: October 28, 2024
Revised: December 29, 2024
Accepted: January 16, 2025
Published online: April 15, 2025
Processing time: 123 Days and 19.2 Hours
BACKGROUND
Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus (T2DM). It remains unclear whether systolic blood pressure (SBP) status of hypertension is related to coronary inflammation and plaques in T2DM.
AIM
To evaluate whether SBP variability (SBPV) and levels of hypertension are related to coronary inflammation and plaques in T2DM patients using coronary computed tomography angiography (CCTA).
METHODS
This retrospective study involved 881 T2DM patients with CCTA images, including 668 hypertension and 213 normotension patients. Hypertension patients were subgroup based on SBP status: (1) SBPV: Low (< 8.96 mmHg) and high (≥ 8.96 mmHg) groups; and (2) SBP levels: Controlled (< 140 mmHg) and uncontrolled (≥ 140 mmHg) groups. Pericoronary adipose tissue (PCAT) attenuation, high-risk plaques (HRPs) and obstructive stenosis (OS) were evaluated by CCTA. Propensity score matching was utilized to compare these CCTA findings for these groups. The impact of SBPV and SBP levels of hypertension on these CCTA findings in T2DM patients were evaluated by multivariate logistic regression and multivariable linear regression.
RESULTS
PCAT attenuation of the left anterior descending artery (LAD), any low attenuation plaque (LAP), any spotty calcification (SC), any positive remodeling (PR), and OS had significant differences between the hypertension group and the normotension group, as well as between the high SBPV or uncontrolled SBP group and the low SBPV or controlled SBP group (all P < 0.05). Hypertension was independently positively correlated with LAD-PCAT attenuation (β = 1.815, P = 0.010), LAP (OR = 1.612, P = 0.019), SC (OR = 1.665, P = 0.013), PR (OR = 1.549, P = 0.033), and OS (OR = 1.928, P = 0.036) in all T2DM patients. Additionally, high SBPV and uncontrolled SBP were independently positively correlated with LAD-PCAT attenuation (high SBPV: β = 1.673, P = 0.048; uncontrolled SBP: β = 2.370, P = 0.004) and PR (high SBPV: OR = 1.903, P = 0.048; uncontrolled SBP: OR = 2.230, P = 0.013) in T2DM patients with hypertension.
CONCLUSION
Inadequately controlled hypertension, including high SBPV and/or uncontrolled SBP levels, may be related to increased coronary artery inflammation, HRPs, and OS in T2DM, leading to increased cardiovascular risk. Achieving both low SBPV and controlled SBP levels simultaneously, especially in individuals with T2DM and hypertension, warrants clinical attention.
Core Tip: Pericoronary adipose tissue attenuation, high-risk plaques (HRPs), and obstructive stenosis (OS) are major risk factors for cardiovascular disease evaluated using coronary computed tomography angiography. Our findings demonstrated that inadequately controlled hypertension, including high systolic blood pressure variability (SBPV) and/or uncontrolled systolic blood pressure (SBP) levels, may be related to increased coronary inflammation, HRPs, and OS in type 2 diabetes mellitus (T2DM), leading to increased cardiovascular risk. Achieving both low SBPV and controlled SBP levels simultaneously, especially in individuals with T2DM and hypertension, warrants clinical attention.
