Long-term prognosis for individuals with hypertension undergoing coronary artery calcium scoring

Background: To examine the performance of coronary artery calcification (CAC) for stratifying long-term risk of death in asymptomatic hypertensive patients. Methods and results: 8905 consecutive asymptomatic individuals without cardiovascular disease or diabeteswho underwent CAC testing(mean age 53.3±10.5, 59.3% male) were followed for amean of 14 years and categorized on the background of hypertension as well as age above or below 60 years (in accordance with the 2014 Guidelines fromthe Joint National Committee 8). The prevalence and severity of CACwere higher for thosewith hypertension versus without hypertension (P b 0.001), and the extent increased proportionally with advancing age (P b 0.001). Following adjustment, the presence of CAC in hypertensivewith respect to normotensive, was associated with worse prognosis for individuals above the age of 60 years (HR 7.74 [95% CI: 5.15-11.63] vs. HR 4.83 [95% CI: 3.18-7.33]) than individuals below the age of 60 (HR 3.18 [95% CI: 2.42-4.19] vs. HR 2.14 [95% CI: 1.61- 2.85]), respectively. A zero CAC score in hypertensive over the age of 60 years was associated with a lower but persisting risk of mortality for (HR 2.48 [95% CI: 1.50-4.08]) that was attenuated non-significant for those below the age of 60 years (P=0.09). In a "low risk" hypertensive population, the presence any CAC was associated with an almost five-fold (HR 4.68 [95% CI: 2.22-9.87]) increased risk of death. Conclusion: The presence and extent of CAC effectively may help the clinicians to further discriminate the longterm risk of mortality among asymptomatic hypertensive individuals, beyond conventional cardiovascular risk and current guidelines.