Abstract
<title>Abstract</title> <p>Background Hypertension is a major determinant of coronary artery disease and is closely associated with coronary artery calcification. However, the underlying mechanisms have been underexplored, and the relationship between blood pressure (BP) and plaque morphology has not been thoroughly investigated. Methods In this retrospective multicenter study, 293 patients undergoing optical coherence tomography (OCT)-guided percutaneous coronary intervention were enrolled. Patients were categorized according to the stage of hypertension and tertiles of systolic BP (SBP) and diastolic BP (DBP). Detailed OCT-guided qualitative plaque characteristics, including calcification, lipid components, and features of plaque vulnerability, were evaluated. Multivariable generalized linear models were used to assess the associations between BP parameters and OCT findings after adjustment for clinical confounders. Results The stages of hypertension were associated with a greater maximal calcium arc. Both SBP and DBP were associated with a greater maximal calcification arc. In contrast, BP parameters were not consistently associated with OCT-defined features of plaque vulnerability, including thin-cap fibroatheroma and lipid-rich plaque. The association between BP and coronary calcification was more pronounced in patients presenting with acute coronary syndrome than in those with chronic coronary syndrome. These relationships remained significant after multivariable adjustment. Conclusion Both SBP and DBP were associated with more significant coronary calcification rather than vulnerable plaque features.</p>