Relationship of blood pressure measures with coronary artery calcification.

BACKGROUND: Increased blood pressure level is a major risk factor for coronary artery disease. Previous studies of relationships of blood pressure level and hypertension status with coronary artery calcification (CAC), a measure of subclinical atherosclerosis, were restricted to participants who were physician- or self-referred, high risk, selected on hypertension status, or young adults. MATERIAL/METHODS: 803 asymptomatic individuals at least age 40 years were studied from a community. Blood pressure level was measured and blood pressure diagnostic category (i.e. hypertension vs. normotension) was determined by considering reported history of physician-diagnosed hypertension, use of antihypertensive medication, and measured blood pressure levels. CAC was measured non-invasively with electron beam computed tomography. Tobit regression models allowed simultaneous modeling of presence and quantity of CAC. RESULTS: In men, age, having ever smoked, having hypertension, LDL-C level, and body mass index were significantly and positively associated with presence and quantity of CAC. In women, age, systolic blood pressure level, use of lipid lowering medications, and waist-to-hip ratio were significantly and positively associated with presence and quantity of CAC. Relationships of measures of blood pressure with CAC were modified by age, but no other risk factors, in both sexes. CONCLUSIONS: Our results indicated that measures of blood pressure make a relatively large contribution to predictions of CAC at younger ages. CAC quantification, especially among younger individuals, may allow for early assessment of the presence and extent of target organ disease.

Electron beam tomography of interpulmonary saddle embolism: extent and vascular distribution.

PURPOSE: The purpose of this work was to assess morphology and secondary signs of interpulmonary emboli extending across the bifurcation of the main pulmonary artery (PA). METHOD: Retrospective evaluation of 780 electron beam tomographic studies of the chest yielded 17 cases of interpulmonary saddle embolism. Length, diameter, vascular distribution of the emboli, and secondary findings were prospectively assessed by two blinded reviewers. Follow-up studies were carried out in 12 of 17 patients (71%). RESULT: Mean total length of the emboli was 46.6 cm (range 20.9-81.5 cm). The mean diameter of the saddle embolus was significantly smaller at the level of the bifurcation than in the left or right PA (4.5, 7.7, and 7.4 mm, respectively; p < 0.01). Dilatation of the right heart was found in 10 of 17 cases (59%). At follow-up, the saddle state was no longer present in 8 of 12 patients (67%). CONCLUSION: Interpulmonary saddle emboli appear to be a transient form of acute pulmonary embolism, the site of predilection for rupture of the embolus being the level of the bifurcation. Their frequency may therefore be underestimated.