Researchers at Johns Hopkins University School of Medicine are using heart CT scans to create a more personalized treatment for patients with pre-hypertension.
The team used data from a national study and found that heart CT scans used to detect calcium levels in the arteries of the heart can be helpful in creating treatment plans for high blood pressure.
Coronary artery calcium scores had previously been used to determine if patients’ need to be put on statins, not for assessment for potential treatment of high blood pressure.
But researchers have found that the more calcium in arteries indicated high blood pressure requiring a more aggressive treatment, while little to no calcium was indicative of lower blood pressure and less aggressive treatment.
“If a health care provider wants to target blood pressure in a patient with traditional heart disease risk factors and above-normal blood pressure, he or she can look at coronary artery calcium to help with tiebreakerlike decisions,” J. William McEvoy, assistant professor of medicine and member of the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University School of Medicine, says in a press release.
“Our study, along with others, such as SPRINT and HOPE, positions cardiac risk and coronary artery calcium as helpful ways to determine if a given patient would either benefit from more intensive blood pressure control or do just fine with a more traditional blood pressure target.”
In the previous SPRINT trial in 2015, researchers found that patients with increased risk of heart disease responded well to treatment when their systolic blood pressure target was set for 120 millimeters of mercury instead of the traditional 140.
But not all patients with borderline above normal to high blood pressure need that type of aggressive treatment, and according to McEvoy, some patients actually can have a negative reaction to higher doses of blood pressure medications.
“We can predict that about 15 out of every 100 people with a particular risk score will die of a heart attack, but the equations don’t tell us which of those people will be one of the actual 15; they don’t give us personalized information,” McEvoy states.
The study followed 3,733 people who had systolic blood pressure between 120 and 179 over a 10-year period and found that patients with calcium scores of zero with a high risk of heart disease had a low rates of having a heart attack or stroke.
Patients with systolic blood pressure of less than 140 with a low risk of heart disease but who had a calcium score over 100 had a high rate of having a heart attack or stroke.
“It may be that if patients are in that blood pressure treatment gray zone with a high risk score but their coronary artery calcium score is zero, then they don’t need to be treated aggressively to 120 millimeters of mercury and can be treated to 140 instead,” McEvoy suggests. “But if patients have a high calcium score and are in the gray zone, then it would make sense to go with 120 as a treatment goal.”