Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry

Ki Bum Won; Su Yeon Choi; Eun Ju Chun; Sung Hak Park; Jidong Sung; Hae Ok Jung; Hyuk Jae Chang

doi:10.1136/bmjopen-2025-103993

Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry

Ki Bum Won
, Su Yeon Choi
, Eun Ju Chun
, Sung Hak Park
, Jidong Sung
, Hae Ok Jung
, Hyuk Jae Chang

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives To assess the association of normal systolic blood pressure maintenance (SBP_maintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk. Design Retrospective cohort study with a mean follow-up of 3.3 years. Setting Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed. Participants 10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBP_maintain (<120mmHg) and ≥elevated SBP_maintain (≥120mmHg) at the time of follow-up CAC scan. Main outcome measures CAC progression was defined as a difference of ≥2.5 between the square roots (√) of the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS). Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by the interscan period. Results Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, p<0.001) during a mean follow-up of 3.3 years. Normal SBP_maintain was inversely associated with an annualised Δ√transformed CACS (β: −0.18, 95% CI: −0.25 to −0.12, p<0.001) in non-diabetics, but not in diabetics (β: −0.07, 95%CI: −0.31 to 0.19, p=0.631). After consecutive adjustments of age, sex, hypertension, dyslipidaemia, obesity, current smoking and baseline CACS, normal SBP_maintain showed a lower risk of CAC progression than ≥elevated SBP_maintain in non-diabetics; however, this association was not observed in patients with diabetes. Conclusions Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.

Original language	English
Article number	e103993
Journal	BMJ Open
Volume	15
Issue number	10
DOIs	https://doi.org/10.1136/bmjopen-2025-103993
State	Published - Oct 2025

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Blood Pressure
Coronary heart disease
Diabetes Mellitus, Type 2
Primary Prevention

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Won, K. B., Choi, S. Y., Chun, E. J., Park, S. H., Sung, J., Jung, H. O., & Chang, H. J. (2025). Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry. BMJ Open, 15(10), Article e103993. https://doi.org/10.1136/bmjopen-2025-103993

Won, Ki Bum ; Choi, Su Yeon ; Chun, Eun Ju et al. / Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults : a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry. In: BMJ Open. 2025 ; Vol. 15, No. 10.

@article{ce6980944b85446fb19904917bd0e453,

title = "Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry",

abstract = "Objectives To assess the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk. Design Retrospective cohort study with a mean follow-up of 3.3 years. Setting Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed. Participants 10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5\% male; 14.2\% diabetes) were enrolled. Participants were divided into two groups: normal SBPmaintain (<120mmHg) and ≥elevated SBPmaintain (≥120mmHg) at the time of follow-up CAC scan. Main outcome measures CAC progression was defined as a difference of ≥2.5 between the square roots (√) of the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS). Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by the interscan period. Results Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4\% vs 47.3\%, p<0.001) during a mean follow-up of 3.3 years. Normal SBPmaintain was inversely associated with an annualised Δ√transformed CACS (β: −0.18, 95\% CI: −0.25 to −0.12, p<0.001) in non-diabetics, but not in diabetics (β: −0.07, 95\%CI: −0.31 to 0.19, p=0.631). After consecutive adjustments of age, sex, hypertension, dyslipidaemia, obesity, current smoking and baseline CACS, normal SBPmaintain showed a lower risk of CAC progression than ≥elevated SBPmaintain in non-diabetics; however, this association was not observed in patients with diabetes. Conclusions Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.",

keywords = "Blood Pressure, Coronary heart disease, Diabetes Mellitus, Type 2, Primary Prevention",

author = "Won, \{Ki Bum\} and Choi, \{Su Yeon\} and Chun, \{Eun Ju\} and Park, \{Sung Hak\} and Jidong Sung and Jung, \{Hae Ok\} and Chang, \{Hyuk Jae\}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.",

year = "2025",

month = oct,

doi = "10.1136/bmjopen-2025-103993",

language = "English",

volume = "15",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "10",

}

Won, KB, Choi, SY , Chun, EJ, Park, SH, Sung, J, Jung, HO & Chang, HJ 2025, 'Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry', BMJ Open, vol. 15, no. 10, e103993. https://doi.org/10.1136/bmjopen-2025-103993

Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry. / Won, Ki Bum; Choi, Su Yeon ; Chun, Eun Ju et al.
In: BMJ Open, Vol. 15, No. 10, e103993, 10.2025.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults

T2 - a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry

AU - Won, Ki Bum

AU - Choi, Su Yeon

AU - Chun, Eun Ju

AU - Park, Sung Hak

AU - Sung, Jidong

AU - Jung, Hae Ok

AU - Chang, Hyuk Jae

PY - 2025/10

Y1 - 2025/10

N2 - Objectives To assess the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk. Design Retrospective cohort study with a mean follow-up of 3.3 years. Setting Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed. Participants 10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBPmaintain (<120mmHg) and ≥elevated SBPmaintain (≥120mmHg) at the time of follow-up CAC scan. Main outcome measures CAC progression was defined as a difference of ≥2.5 between the square roots (√) of the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS). Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by the interscan period. Results Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, p<0.001) during a mean follow-up of 3.3 years. Normal SBPmaintain was inversely associated with an annualised Δ√transformed CACS (β: −0.18, 95% CI: −0.25 to −0.12, p<0.001) in non-diabetics, but not in diabetics (β: −0.07, 95%CI: −0.31 to 0.19, p=0.631). After consecutive adjustments of age, sex, hypertension, dyslipidaemia, obesity, current smoking and baseline CACS, normal SBPmaintain showed a lower risk of CAC progression than ≥elevated SBPmaintain in non-diabetics; however, this association was not observed in patients with diabetes. Conclusions Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.

AB - Objectives To assess the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk. Design Retrospective cohort study with a mean follow-up of 3.3 years. Setting Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed. Participants 10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBPmaintain (<120mmHg) and ≥elevated SBPmaintain (≥120mmHg) at the time of follow-up CAC scan. Main outcome measures CAC progression was defined as a difference of ≥2.5 between the square roots (√) of the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS). Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by the interscan period. Results Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, p<0.001) during a mean follow-up of 3.3 years. Normal SBPmaintain was inversely associated with an annualised Δ√transformed CACS (β: −0.18, 95% CI: −0.25 to −0.12, p<0.001) in non-diabetics, but not in diabetics (β: −0.07, 95%CI: −0.31 to 0.19, p=0.631). After consecutive adjustments of age, sex, hypertension, dyslipidaemia, obesity, current smoking and baseline CACS, normal SBPmaintain showed a lower risk of CAC progression than ≥elevated SBPmaintain in non-diabetics; however, this association was not observed in patients with diabetes. Conclusions Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.

KW - Blood Pressure

KW - Coronary heart disease

KW - Diabetes Mellitus, Type 2

KW - Primary Prevention

UR - https://www.scopus.com/pages/publications/105020165770

U2 - 10.1136/bmjopen-2025-103993

DO - 10.1136/bmjopen-2025-103993

M3 - Article

C2 - 41151958

AN - SCOPUS:105020165770

SN - 2044-6055

VL - 15

JO - BMJ Open

JF - BMJ Open

IS - 10

M1 - e103993

ER -

Won KB, Choi SY , Chun EJ, Park SH, Sung J, Jung HO et al. Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry. BMJ Open. 2025 Oct;15(10):e103993. doi: 10.1136/bmjopen-2025-103993

Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry

Abstract

Bibliographical note

UN SDGs

Keywords

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