ABC | Volume 114, Nº1, January 2019

Original Article Aortic Arch Calcification on Routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern Adem Adar, 1 Orhan Onalan, 1 Fahri Cakan, 1 Ertan Akbay, 1 Ekrem Karakaya 1 Karabuk University Faculty of Medicine – Cardiology, 1 Karabuk – Turkey Mailing Address: Adem Adar • Karabuk University Faculty of Medicine – Cardiology, 78050, Karabuk – Turkey E-mail: dradaradem@gmail.com Manuscript received August 19, 2018, revised manuscript February 28, 2019, accepted March 20,2019 DOI: 10.5935/abc.20190229 Abstract Background: Non-dipper blood pressure (NDBP) is one of the important causes of hypertension-related target organ damage and future cardiovascular events. Currently, there is no practical tool to predict NDBP pattern. Objectives: The aim of this study was to investigate the relationship between aortic arch calcification (AAC) on chest radiography and NDBP pattern. Methods: All patients referred for ambulatory BP monitoring test were approached for the study participation. NDBP was defined as the reduction of ≤10% in nighttime systolic BP as compared to the daytime values. AAC was evaluated with chest radiography and inter-observer agreement was analyzed by using kappa statistics. Univariate and multivariate logistic regression analysis was conducted to assess the association of AAC and NDBP pattern. A 2-tailed p-value < 0.05 was considered statistically significant. Results: A total of 406 patients (median age: 51.3) were included. Of these, 261(64%) had NDBP pattern. Overall, the prevalence of AAC was 230 (57%). Non-dipper group had significantly higher prevalence of AAC (70% vs. 33%, p < 0.0001) as compared to the dipper group. Presence of AAC was a strong and independent predictor of NDBP pattern (OR 3.919, 95%CI 2.39 to 6.42) in multivariate analysis. Conclusions: Presence of AAC on plain chest radiography is strongly and independently associated with the presence of NDBP pattern. (Arq Bras Cardiol. 2020; 114(1):109-117) Keywords: Thoracic, Aorta/physiopathology; Calcification; Calcinosis; Cardiomyopathies; Hypertension/imaging diagnosis; Ventricular Function,Left; Antihypertensive Agents/therapeutic use;Blood Pressure Monitoring Ambulatory; Heart Rate. Introduction Hypertension (HT) is the most common cardiovascular disease and it is the leading cause of cardiovascular mortality and morbidity. Blood pressure (BP) follows a circadian pattern with a nocturnal decline of %10 or more as compared with daytime BP. Non-dipper BP (NDBP) pattern is defined as the absence of normal nocturnal decline in BP as compared to daytime measurements. NDBP pattern is associated with disease severity, left ventricular hypertrophy (LVH), proteinuria, secondary forms of HT and insulin resistance. 1-4 Several forms of HT including NDBP pattern can only be detected by ambulatory BP monitoring (ABPM). Moreover, ABPM is superior to office BP measurements in predicting cardiovascular risk. 5,6 However, utilization of ABPM to unselected population is not practical and currently, there is no practical tool to predict NDBP pattern. NDBP pattern has shown to be associated with arterial stiffness. 4,7,8 Vascular calcification plays an important role in the development of arterial stiffness. 9,10 Accordingly, aortic arch calcification (AAC) has been shown to be closely related to arterial stiffness. 11,12 Thus, we hypothesized that AAC on chest radiography predicts NDBP pattern. Methods Study population All patients who were referred for ABPM test were approached for the study participation. Indication for ABPM test was left to physician discretion. Following inclusion criteria, we applied: 1) Age ≥ 18-years-old; 2) A valid measurement rate of >85% during the ABPM test. Nighttime workers, patients with inadequate chest x-ray, pregnancy or suspicion of pregnancy, history of moderate to severe cardiac valve disease, malignancy, cardiac or thoracic surgery, coronary artery, cerebrovascular and peripheral vascular disease were excluded from the study. Posterior-anterior (PA) chest radiography and transthoracic echocardiography were performed in all patients. Eligible subjects underwent a comprehensive assessment, including documentation of medical history, physical examination and measurement of laboratory variables. Body mass index was calculated as the weight in kilogram divided by height in square meter. Diabetes was defined as being on treatment with insulin or oral anti-diabetic drugs. HT and hyperlipidemia were defined as the use of anti-hypertensive 109