Thoracic aortic calcification in patients with resistant hypertension

Aim . To evaluate thoracic aortic calcification and parameters of 24-hour ambulatory blood pressure monitoring (ABPM) in patients with resistant hypertension (HTN). Material and methods . The study included 138 patients diagnosed with resistant HTN. Based on ABPM (Schiller BR-102 plus), the patients were divided into groups of controlled (Group 1, n=68) and uncontrolled resistant HTN (Group 2, n=70). Thoracic aortic calcium score was determined using a 64-slice computed tomography system (Siemens, Germany). Results . No significant differences were found between the groups in the key clinical and anthropometric characteristics. The Agatston calcium score ranged from 312 to 2738 and was higher in the group of uncontrolled HTN (p<0,00001). ROC analysis found that calcium score of 900 with a sensitivity of 71,4% and a specificity of 66,2% differentiates individuals with controlled and uncontrolled resistant HTN (AUC=0,791). According to ABPM, the most significant differences were obtained when comparing pulse pressure, 24-hour systolic blood pressure (BP) index, morning surge, and daytime systolic BP variability. Regardless of the effectiveness of antihypertensive therapy, the calcium score correlated positively with the variability of systolic BP, pulse BP, and morning surge, and negatively with the 24-hour systolic BP index, but the relationship strength was greater when the target BP was not reached. Conclusion . In patients with resistant HTN without BP control, higher values of pulse pressure, morning surge, and systolic BP variability, and a decrease in the 24-hour systolic BP index were noted. The calcium index was higher in the group of patients with uncontrolled resistant HTN and was associated with the variability of systolic BP, pulse pressure, morning surge, and nocturnal systolic BP decrease.