Prediction of incident hypertension with the coronary artery calcium score based on the 2017 ACC/AHA high blood pressure guidelines

Coronary artery calcification (CAC), a marker of atherosclerosis, is predictive of incident hypertension based on the 2017 ACC/AHA high blood pressure guidelines. We performed a large cohort study to investigate whether incident hypertension could be predicted from CAC measurements as a measure of atherosclerosis, even when updated hypertension criteria are applied. A total of 27,918 male subjects who underwent CAC examination during a health screening program between 2011 and 2017 were enrolled. According to the 2017 ACC/AHA guidelines, hypertension was defined as 130/80 mmHg. Cox proportional hazard analysis was used to assess the risk of incident hypertension according to CAC categories (CAC = 0, 1–10, 11–100, >100). After exclusion, 14,335 subjects were included (mean age 40.0 [5.7] years). During the follow-up period (median 3.63 years), 3050 subjects (21.3%) developed hypertension. The subjects in the highest CAC category showed an increased risk of hypertension compared with the lowest CAC category, as confirmed by multivariate adjusted hazard ratios of 1.27 (95% confidence interval [CI], 1.01–1.60; P < 0.001). The increased risk of developing hypertension was consistent after adjustments were made for several confounding factors. The CAC score, a marker of atherosclerosis, is positively associated with incident hypertension according to the updated 2017 ACC/AHA guidelines.