Johns Hopkins researchers find personalized treatment effective for ‘gray zone’ blood pressure patients

New research from Johns Hopkins found that by using heart CT scans, physicians could give patients with “gray zone” blood pressure—or slightly higher than normal blood pressure—personalized treatment.

Existing treatments for patients in the gray zone haven’t been entirely successful and often leave patients more vulnerable to heart disease or taking unnecessary medications. But findings from this new study, published in Circulation, can provide a better and safer way for physicians to identify proper course of treatment.

Using CT scans, the researchers were able to detect levels of calcium in the heart’s arteries, which served as a measure for whether they needed aggressive blood pressure treatment or other, less intense forms of treatment. Those with high calcium levels would benefit from blood pressure 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 tie-breaker-like decisions," said J. William McEvoy, MBBCh, assistant professor of medicine and member of the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine. "Our study, along with others, 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."

The investigators used data from 3,733 participants in the Multi-Ethnic Study of Atherosclerosis (MESA), all of whom had systolic blood pressures between 120 and 179 millimeters of mercury. On average, patients were 65 years old, and 48 percent of them were men. They were also a diverse bunch, with 35 percent of them being white, 32 percent of them black, 22 percent were Hispanic and 11 percent were Chinese-American.

The researchers measured their blood pressure and performed a cardiac CT scan on them at the beginning of the study to determine their coronary artery calcium scores. They then checked in with participants once a year for 10 years. After 10 years, the participants had 642 heart disease events, like heart attack, heart failure, stroke and death.

Based on those events and their coronary artery calcium scores, the researchers divided the participants into three scores. Results showed that patients with calcium scores of zero with a high calculated risk of heart disease had a low actual even rate after 10 years. But patients with systolic blood pressure in 140 millimeters of mercury with a low predicted risk of heart disease and had a calcium score of more than 100, had a high actual even rate of about 19.7 events per 1,000 person-years.

"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 said. "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."