Aortic plaque characteristics and hypertension: insights from non-obstructive general angioscopy

Abstract

Hypertension affects approximately 40 million individuals in Japan and is a major risk factor for atherosclerotic cardiovascular disease. The aorta, the largest artery in the human body, reflects the systemic burden of atherosclerosis; however, qualitative assessment of aortic plaques in vivo has been challenging. Non-obstructive general angioscopy (NOGA) enables direct visualization of aortic plaque morphology and has previously been shown to predict cardiovascular events. This study aimed to evaluate the relationship between hypertension and aortic plaque instability detected by NOGA. We analyzed 432 consecutive patients who underwent NOGA of the aorta during cardiac catheterization. Aortic findings—including plaque rupture (PR), thrombus, ulceration, fissure, and yellow plaque—were systematically assessed. The frequency of each lesion was calculated as the number of lesions per observed vertebral segment. Of the study population, 320 patients (74%) had hypertension. Compared with non-hypertensive patients, those with hypertension showed a significantly higher frequency of PR (15% vs 8%, p<0.001) and yellow plaque (58% vs 53%, p=0.035), whereas other lesions did not differ significantly. In multivariate analysis, hypertension remained independently associated with a higher frequency of PR (odds ratio 2.03, 95% CI 1.05–3.96, p=0.035). Segment-specific analysis revealed that PR was significantly more frequent in the descending thoracic aorta (20% vs 10%, p<0.001). Hypertensive patients demonstrated a significantly higher frequency of aortic PR as assessed by NOGA. Given that PR represents a high-risk feature of aortic atherosclerosis, hypertension may contribute not only to plaque burden but also to plaque destabilization in the aorta.Non-Obstructive Angioscopy FindingsFor image description, please refer to the figure legend and surrounding text.