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(Circulation. 2000;102:2087.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Independent Association of High Blood Pressure and Aortic Atherosclerosis

A Population-Based Study

Presented in part at the 72nd Scientific Sessions of the American Heart Association, Atlanta, Ga, November 7–10, 1999, and published in abstract form (Circulation 1999;100[suppl I]:I-231).

Yoram Agmon, MD; Bijoy K. Khandheria, MD; Irene Meissner, MD; Gary L. Schwartz, MD; Tanya M. Petterson, MS; W. Michael O’Fallon, PhD; Federico Gentile, MD; Jack P. Whisnant, MD; David O. Wiebers, MD; James B. Seward, MD

From the Division of Cardiovascular Diseases and Internal Medicine (Y.A., B.K.K., F.G., J.B.S.), the Department of Neurology (I.M., D.O.W.), the Division of Hypertension and Internal Medicine (G.L.S.), and the Department of Health Science Research (T.M.P., W.M.O., J.P.W.), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Correspondence to Bijoy K. Khandheria, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail khandheria{at}mayo.edu

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 subjects, a random sample of the Olmsted County (Minnesota) population aged 45 years participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. Blood pressure was assessed by multiple office measurements and 24-hour ambulatory blood pressure monitoring. The association between blood pressure variables and aortic atherosclerosis was evaluated by multiple logistic regression, adjusting for other associated variables. Among subjects with atherosclerosis, blood pressure variables associated with complex aortic atherosclerosis (protruding plaques 4 mm thick, mobile debris, or ulceration) were determined. Age and smoking history were independently associated with aortic atherosclerosis of any degree (P0.001) and with complex atherosclerosis (P=0.002), whereas sex, diabetes mellitus, and body mass index were not. Multiple systolic and pulse pressure variables (office and ambulatory), but none of the diastolic blood pressure variables, were associated with atherosclerosis and complex atherosclerosis, adjusting for age and smoking. Among subjects with atherosclerosis, the odds of complex atherosclerosis increased as ambulatory out-of-bed systolic blood pressure increased (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 atherosclerosis. Among subjects with atherosclerosis, high blood pressure is associated with complex atherosclerosis.

Key Words: aorta • atherosclerosis • blood pressure • echocardiography • hypertension

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