Effect of systolic blood pressure status on coronary inflammation and high-risk plaque characteristics

doi:10.4239/wjd.v16.i4.102751

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Apr 15, 2025 (publication date) through Feb 28, 2025

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Diabetes. Apr 15, 2025; 16(4): 102751
Published online Apr 15, 2025. doi: 10.4239/wjd.v16.i4.102751

Table 1 Clinical baseline characteristics of the normotension group, low systolic blood pressure variability group, and high systolic blood pressure variability group

Variables	Normotension group, n = 213	Low SBPV group, n = 334	High SBPV group, n = 334	P value
Baseline characteristic
Age (years)	58.24 ± 9.32	61.83 ± 10.19^a	65.03 ± 10.88^a^,^b	< 0.001
Male sex	90 (42.3)	164 (49.1)	193 (57.8)^a^,^b	0.001
Body mass index (kg/m²)	23.71 ± 3.15	24.12 ± 3.13	24.73 ± 3.99^a	0.009
Smoking	33 (15.5)	57 (17.1)	71 (21.2)	0.187
Dyslipidemia	94 (44.1)	135 (40.4)	163(48.8)	0.115
Systolic pressure (mmHg)	118 ± 9	136 ± 10^a	149 ± 16^a^,^b	< 0.001
Diastolic pressure (mmHg)	73 ± 8	78 ± 11^a	85 ± 14^a^,^b	< 0.001
Laboratory findings
Fast glucose (mmol/L)	6.68 ± 2.87	7.66 ± 2.82	7.72 ± 3.93^a^,^b	0.005
HbA1c (%)	7.37 ± 2.36	7.42 ± 1.86^a	7.79 ± 1.97^a	0.027
Triglyceride (mmol/L)	1.36 (0.91, 1.82)	1.46 (0.81, 2.11)	1.55 (0.68, 2.41)^a^,^b	0.001
Total cholesterol (mmol/L)	4.41 ± 1.20	4.44 ± 1.19	4.64 ± 1.26^a	0.004
HDL-cholesterol (mmol/L)	1.25 ± 0.36	1.26 ± 0.35	1.28 ± 0.38^a^,^b	0.007
LDL-cholesterol (mmol/L)	2.59 ± 0.85	2.69 ± 0.95	2.79 ± 0.96^a^,^b	< 0.001
Lipid - lowering medication
Statin	128 (60.1)	214 (64.1)	261 (78.1)^a^,^b	0.001
Hypertension treatment
ARB/ACEI	-	128 (38.3)	82 (24.6)^b	< 0.001
Beta - blocker	-	87 (26.1)	65 (19.5)	0.064
Diuretics	-	27 (8.1)	22 (6.6)	0.830
Calcium channel blocker	-	119 (35.6)	163 (48.8)^b	0.001
Diabetes treatment
Oral	77 (36.1)	142 (42.5)	183 (54.8)^a^,^b	< 0.001
Insulin	36 (16.9)	57 (17.1)	70 (20.1)	0.192
Tube voltage of CT acquisition (kVp)				0.002
100	139 (65.3)	183 (54.8)	152 (45.5)
120	71 (33.4)	144 (43.1)	158 (47.3)
140	3 (1.4)	7 (2.1)	24 (7.2)

^aP < 0.005 vs the normotension group.

^bP < 0.005 vs the low systolic blood pressure variability group.

Data are showed as means ± SD, median (25^th and 75^th percentile), or n (%). SBPV: Systolic blood pressure variability; HbA1c: Glycated hemoglobin; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; ARB/ACEI: Angiotensin receptor blockers/angiotensin-converting enzyme inhibitors; CT: Computed tomography.

Table 2 Clinical baseline characteristics of the normotension group, controlled systolic blood pressure group, and uncontrolled systolic blood pressure group

Variables	Normotension group, n = 213	Controlled SBP group, n = 313	Uncontrolled SBP group, n = 355	P value
Baseline characteristic
Age (years)	58.15 ± 9.24	62.80 ± 10.07^a	63.16 ± 11.16^a	< 0.001
Male sex	90 (42.3)	156 (49.8)^a	201 (56.6)^a	0.00
Body mass index (kg/m²)	23.71 ± 3.16	24.39 ± 3.40	24.43 ± 3.78^a	0.030
Smoking	33 (15.5)	51 (16.3)	72 (20.3)	0.208
Dyslipidemia	94 (44.1)	121 (38.7)	157(44.2)	0.379
Systolic pressure (mmHg)	118 ± 9	125 ± 8^a	153 ± 15^a^,^b	< 0.001
Diastolic pressure (mmHg)	73 ± 8	76 ± 10^a	87 ± 13^a^,^b	< 0.001
Laboratory findings
Fast glucose (mmol/L)	6.45 ± 2.48	7.31 ± 4.10	7.45 ± 3.69	0.065
HbA1c (%)	7.37 ± 2.36	6.76 ± 1.84	7.11 ± 1.96^a^,^b	0.040
Triglyceride (mmol/L)	1.36 (0.91, 1.82)	1.43 (0.83, 2.03)	1.50 (0.62, 2.38)^a	0.027
Total cholesterol (mmol/L)	4.41 ± 1.20	4.61 ± 1.24	4.80 ± 1.05^a	0.006
HDL-cholesterol (mmol/L)	1.25 ± 0.36	1.21 ± 0.35	1.22 ± 0.38	0.530
LDL-cholesterol (mmol/L)	2.59 ± 0.85	2.73 ± 1.00^a	2.99 ± 0.90^a	< 0.001
Lipid - lowering medication
Statin	127 (59.6)	207 (66.1)	260 (73.2)^a^,^b	0.001
Hypertension treatment
ACEI/ARB	-	105 (33.5)	106 (29.9)	0.387
Beta - blocker	-	51 (16.3)	50 (14.1)	0.261
Diuretics	-	26 (8.3)	21 (5.9)	0.394
Calcium channel blocker	-	167 (53.4)	162 (45.6)	0.099
Diabetes treatment
Oral	70 (32.9)	100 (31.9)	124 (34.9)	0.762
Insulin	15 (7.0)	27 (8.6)	31 (8.7)	0.647
Tube voltage of CT acquisition				0.001
100	139 (65.3)	174 (55.6)	161 (45.4)
120	71 (33.4)	131 (41.9)	171 (48.2)
140	3 (1.4)	8 (2.6)	23 (6.5)

^aP < 0.005 vs the normotension group.

^bP < 0.005 vs the controlled group.

Data are showed as means ± SD, median (25^th and 75^th percentile), or n (%). SBP: Systolic blood pressure; HbA1c: Glycated hemoglobin; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; ARB/ACEI: Angiotensin receptor blockers/angiotensin-converting enzyme inhibitors; CT: Computed tomography.

Table 3 Comparison of the coronary computed tomography angiography parameters between normotension group and hypertension group after matching

	Normotension group, n = 167	Hypertension group, n = 167	P value
Age (years)	58.65 ± 8.75	59.16 ± 8.90	0.598
Male sex, n (%)	69 (41.3)	62 (37.1)	0.433
Body mass index (kg/m²)	23.74 ± 3.14	24.03 ± 3.25	0.657
Smoking, n (%)	29 (17.4)	32 (19.2)	0.671
Dyslipidemia, n (%)	77 (46.1)	76 (45.5)	0.913
Statin, n (%)	107 (64.1)	109 (65.3)	0.819
Tube voltage (kVp), n (%)			0.325
100	107 (64.1)	104 (62.3)
120	58 (34.7)	63 (37.7)
140	2 (1.2)	0 (0.0)
LAD-PCAT (HU)	-77.59 ± 7.44	-76.23 ± 7.45	0.008
LCX-PCAT (HU)	-70.99 ± 7.10	-71.24 ± 7.23	0.759
RCA-PCAT (HU)	-76.80 ± 6.90	-77.05 ± 8.13	0.759
High-risk plaques, n (%)
Any LAP	37 (22.2)	57 (34.1)	0.015
Any SC	51 (30.5)	53 (31.7)	0.013
Any NRS	54 (32.3)	53 (31.7)	0.907
Any PR	87 (52.1)	107 (64.1)	0.027
OS, n (%)	24 (14.4)	43 (25.7)	0.009

Data are showed as means ± SD, median (25^th and 75^th percentile), or n (%). LAD: Left anterior descending artery; LCX: Left circumflex artery; RCA: Right coronary artery; PCAT: Pericoronary adipose tissue; NRS: Napkin-ring sign; SC: Spotty calcification; LAP: Low attenuation plaque; PR: Positive remodeling; OS: Obstructive stenosis.

Table 4 Comparison of the coronary computed tomography angiography parameters between two groups of hypertension patients after matching, n (%)

	Low SBPV group vs high SBPV group			Controlled SBP group vs uncontrolled SBP group
	Low SBPV group, n = 191	High SBPV group, n = 191	P value	Controlled SBP group, n = 191	uncontrolled SBP group, n = 191	P value
Age (years)	64.21 ± 10.90	62.74 ± 9.88	0.168	63.72 ± 10.79	63.26 ± 9.86	0.653
Male sex	112 (58.6)	102 (53.4)	0.303	116 (55.8)	111 (53.4)	0.622
Body mass index (kg/m²)	24.40 ± 3.43	24.47 ± 3.88	0.862	24.39 ± 3.48	24.38 ± 3.79	0.953
Smoking	42 (22.0)	44 (23.0)	0.806	41 (19.7)	47 (22.6)	0.806
Dyslipidemia	83 (43.5)	82 (42.9)	0.918	93 (44.7)	93 (44.7)	1.000
Systolic pressure (mmHg)	136 ± 11	136 ± 13	0.876	-	-	-
SBPV (mmHg)	-	-	-	7.56 ± 1.64	9.07 ± 1.25	0.085
Statin	136 (71.2)	134 (70.2)	0.882	152 (73.1)	151 (72.6)	0.912
Tube voltage (kVp)			0.436			0.951
100	102 (53.4)	101 (52.9)		105 (50.5)	107 (51.4)
120	86 (45.0)	83 (43.5)		96 (46.2)	95 (45.7)
140	3 (1.6)	7 (3.7)		7 (3.4)	6 (2.9)
LAD-PCAT (HU)	-77.41 ± 7.50	-74.70 ± 8.86	0.002	-76.53 ± 7.67	-74.58 ± 8.57	0.016
LCX-PCAT (HU)	-70.95 ± 7.45	-70.18 ± 8.37	0.345	-70.39 ± 7.41	-69.67 ± 8.07	0.354
RCA-PCAT (HU)	-76.38 ± 7.81	-75.80 ± 8.59	0.496	-75.90 ± 7.81	-75.28 ± 8.62	0.381
High-risk plaques
Any LAP	51 (26.7)	84 (44.0)	< 0.001	54 (26.0)	97 (46.6)	< 0.001
Any SC	59 (30.9)	99 (51.8)	< 0.001	63 (30.3)	110 (52.9)	< 0.001
Any NRS	66 (34.6)	72 (37.7)	0.523	70 (33.7)	84 (40.4)	0.155
Any PR	117 (61.3)	155 (81.2)	< 0.001	123 (59.1)	171 (82.2)	< 0.001
OS	35 (18.5)	46 (28.6)	0.026	39 (18.9)	59 (33.1)	0.001

Data are showed as means ± SD, median (25^th and 75^th percentile), or n (%). SBP: Systolic blood pressure; SBPV: Systolic blood pressure variability; LAD: Left anterior descending artery; LCX: Left circumflex artery; RCA: Right coronary artery; PCAT: Pericoronary adipose tissue; NRS: Napkin-ring sign; SC: Spotty calcification; LAP: Low attenuation plaque; PR: Positive remodeling; OS: Obstructive stenosis.

Table 5 Univariate and multivariate linear analysis on pericoronary adipose tissue attenuation of left anterior descending artery in all type 2 diabetes mellitus patients

	Univariate		Multivariate
	β (95%CI)	P value	β (95%CI)	P value
Subgroup
Normotension group	Reference
Hypertension group	1.564 (0.217-2.911)	0.023	1.815 (0.429-3.201)	0.010
Age	0.009 (-0.046-0.064)	0.747
Male sex	2.397 (1.246-3.549)	< 0.001	2.245 (1.037-3.454)	< 0.001
Body mass index	-0.238 (-0.412 to -0.064)	0.008	-0.307(-0.480 to -0.133)	0.001
Smoking	0.729 (-0.780-2.237)	0.343
Dyslipidemia	-1.213 (-2.391 to -0.035)	0.044	-0.682 (-2.081-0.718)	0.339
Fast glucose	-0.054 (-0.226-0.119)	0.543
HbA1c	0.160 (-0.178-0.498)	0.352
Triglyceride	-0.480 (-0.793 to -0.167)	0.003	-0.371 (-0.774-0.033)	0.072
Total cholesterol	-0.239 (-0.739-0.262)	0.350
HDL-cholesterol	1.244 (-0.356-2.844)	0.127
LDL-cholesterol	-0.230 (-0.850-0.389)	0.466
Statin	-0.885 (-2.129-0.359)	0.163
Diabetes treatment	-0.805 (-2.028-0.418)	0.197

HbA1c: Glycated hemoglobin; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; 95%CI: 95% confidence interval.

Table 6 Univariate and multivariate linear analysis on pericoronary adipose tissue attenuation of left anterior descending artery in type 2 diabetes mellitus patients with hypertension

	Univariate		Multivariate
	β (95%CI)	P value	β (95%CI)	P value
Subgroup
Low SBPV group	Reference
High SBPV group	1.055 (0.510-2.527)	0.029	1.673 (0.016-3.330)	0.048
Subgroup
Controlled SBP group	Reference
Uncontrolled SBP group	2.064 (0.577-3.552)	0.017	2.370 (0.755-3.984)	0.004
Age	0.007 (-0.056-0.071)	0.824
Male sex	2.288 (0.933-3.643)	0.001	2.237 (0.824-3.651)	0.962
Body mass index	-0.306 (-0.505 to -0.106)	0.003	-0.317 (-0.513 to -0.120)	0.002
Smoking	0.319 (-1.422-2.061)	0.719
Dyslipidemia	-0.996 (-2.382-0.391)	0.159
Fast glucose	-0.047 (-0.261-0.166)	0.663
HbA1c	0.283 (-0.140-0.705)	0.189
Triglyceride	-0.414 (-0.748 to -0.080)	0.015	-0.445 (-0.817 to -0.072)	0.019
Total cholesterol	-0.135 (-0.704-0.435)	0.643
HDL-cholesterol	1.110 (-0.759-2.979)	0.244
LDL-cholesterol	-0.108 (-0.829-0.613)	0.770
Statin	-0.798 (-2.297-0.700)	0.296
Hypertension treatment	0.829 (-0.534-2.192)	0.233
Diabetes treatment	-0.578 (-2.010-0.854)	0.428

SBPV: Systolic blood pressure variability; SBP: Systolic blood pressure; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; HbA1c: Glycated hemoglobin; 95%CI: 95% confidence interval.

Table 7 Univariate logic regression analysis on adverse coronary computed tomography angiography findings, odds ratio

	All T2DM patients				T2DM patients with hypertension
	LAP	SC	PR	OS	LAP	SC	PR	OS
Subgroup
Normotension group	Reference
Hypertension group	2.337^a	1.906^a	2.328^a	2.757^a	-	-	-	-
Subgroup
Low SBPV group					Reference
High SBPV group	-	-	-	-	1.831^a	1.820^a	2.445^a	2.537^a
Subgroup
Controlled SBP group					Reference
Uncontrolled SBP group	-	-	-	-	2.190^a	2.003^a	3.016^a	3.097^a
Age	1.039^a	1.054^a	1.049^a	1.030^a	1.031^a	1.050^a	1.040^a	0.019
Male sex	1.831^a	1.440^a	2.092^a	1.464^a	1.741^a	1.490^a	1.949^a	1.514^a
Body mass index	1.006	1.034	1.087^a	0.938	1.000	1.026	1.089^a	0.972
Smoking	1.766^a	0.975	2.392	0.985	1.488^a	0.857	2.107^a	0.959
Dyslipidemia	1.234	1.146	1.259	1.646^a	1.183	1.044	1.191	1.791^a
Fast glucose	1.085^a	1.045^a	1.090^a	1.094^a	1.088^a	1.069^a	1.136^a	1.106^a
HbA1c	1.185^a	1.112^a	1.116^a	1.272^a	1.165^a	1.131^a	1.157^a	1.302^a
Triglyceride	1.101^a	1.040	1.166^a	1.070	1.089^a	1.020	1.153^a	1.052
Total cholesterol	0.842^a	0.839^a	0.832^a	0.720^a	0.856^a	0.846^a	0.857^a	0.721^a
HDL-cholesterol	0.513^a	0.682	0.376^a	0.325^a	0.512^a	0.751	0.371^a	0.250^a
LDL-cholesterol	0.770^a	0.758^a	0.776^a	0.613^a	0.778^a	0.763^a	0.796^a	0.613^a
Statin	1.414^a	1.949^a	1.791^a	1.764^a	1.147	1.744^a	1.625^a	1.430
Hypertension treatment	-	-	-	-	1.457^a	1.315	1.529^a	1.841^a
Diabetes treatment	2.648^a	2.001^a	2.241^a	3.064^a	2.402^a	1.847^a	2.219^a	3.319^a

^aP < 0.05.

T2DM: Type 2 diabetes mellitus; SC: Spotty calcification; LAP: Low attenuation plaque; PR: Positive remodeling; OS: Obstructive stenosis; OR: Odds ratio; SBPV: Systolic blood pressure variability; SBP: Systolic blood pressure; LDL: Low-density lipoprotein; HDL: High-density lipoprotein; HbA1c: Glycated hemoglobin.

Table 8 Multivariate logistic analysis on adverse coronary computed tomography angiography findings, odds ratio (95% confidence interval)

	Model 1			Model 2			Model 3
	Normotension group (n = 213)	Hypertension group (n = 668)	P value	Low SBPV Group (n = 334)	High SBPV group (n = 334)	P value	Controlled group (n = 313)	Uncontrolled group (n = 355)	P value
	Reference			Reference			Reference
LAP		1.612 (1.081-2.405)	0.019		-	0.684	-		0.230
SC		1.665 (1.112-2.462)	0.013		-	0.261		-	0.117
PR		1.549 (1.036-2.317)	0.033		1.903 (1.005-3.603)	0.048		2.230 (1.185-4.197)	0.013
OS		1.928 (1.045-3.555)	0.036		-	0.989	-		0.205

OS: Obstructive stenosis; SC: Spotty calcification; LAP: Low attenuation plaque; PR: Positive remodeling.

Citation: Jiang CP, Liu YK, Cheng PP, Dong Y, Wang X, Wu FY, Xia YX, Wang PY, Xu XY. Effect of systolic blood pressure status on coronary inflammation and high-risk plaque characteristics. World J Diabetes 2025; 16(4): 102751
URL: https://www.wjgnet.com/1948-9358/full/v16/i4/102751.htm
DOI: https://dx.doi.org/10.4239/wjd.v16.i4.102751