Independent association of high blood pressure and aortic atherosclerosis - A population-based study

Background-Atherosclerosis of the thoracic aorta is associated with stroke. The association between hypertension, a major risk factor for stroke, and aortic atherosclerosis has not been determined in the general population. Methods and Results-Transesophageal echocardiography was performed in 581 s ubjects, a random sample of the Olmsted County (Minnesota) population aged greater than or equal to 45 years participating in the Stroke Prevention: A ssessment of Risk in a Community (SPARC) study. Blood pressure was assessed by multiple office measurements and 24-hour ambulatory blood pressure moni toring. The association between blood pressure variables and aortic atheros clerosis was evaluated by multiple logistic regression, adjusting for other associated variables. Among subjects with atherosclerosis, blood pressure variables associated with complex aortic atherosclerosis (protruding plaque s greater than or equal to4 mm thick, mobile debris, or ulceration) were de termined. Age and smoking history were independently associated with aortic atherosclerosis of any degree (P less than or equal to0.001) and with comp lex atherosclerosis (P=0.002), whereas sex, diabetes mellitus, and body mas s index were not, Multiple systolic and pulse pressure variables (office an d ambulatory), but none of the diastolic blood pressure variables, were ass ociated with atherosclerosis and complex atherosclerosis, adjusting for age and smoking. Among subjects with atherosclerosis, the odds of complex athe rosclerosis increased as ambulatory out-of-bed systolic blood pressure incr eased (odds ratio 1.43 per 10 mm Hg increase, 95% CI 1.10 to 1.87) and with hypertension treatment, adjusting for age and smoking history. Conclusions-High blood pressure is independently associated with aortic ath erosclerosis. Among subjects with atherosclerosis, high blood pressure is a ssociated with complex atherosclerosis.