"Using data from a national study Johns Hopkins researchers determined that using heart CT scans can help personalize treatment in patients whose blood pressure falls in the gray zone of just above normal or mild high blood pressure. Previously the appropriate blood pressure treatment for these patients used risk calculations and some guesswork potentially leaving many vulnerable to heart disease or taking drugs they dont need. Nearly one in three adults in the U.S. has prehypertension blood pressure higher than normal but not considered high yet. The scans detect levels of calcium in the hearts arteries and the physicians suggest those people with the highest calcium levels would benefit most from aggressive blood pressure treatment whereas those with little or no calcium may not need to be treated as intensively depending on their other heart disease risk factors. In the study published on Jan.  in Circulation httpcirc.ahajournals.orgcontent the researchers say these calcium scores allow physicians to go beyond the traditionally calculated risk factors to determine which blood pressure treatment strategy may be most appropriate for a particular patient. If a health care provider wants to target blood pressure in a patient with traditional heart disease risk factors and abovenormal blood pressure he or she can look at coronary artery calcium to help with tiebreakerlike decisions says J. William McEvoy M.B.B.Ch. M.H.S. http 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 such as SPRINT and HOPE 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. In late  the SPRINT trial showed improved outcomes for participants with increased risk for heart disease whose physicians targeted their systolic the top number blood pressures to  millimeters of mercury rather than the traditional  millimeters of mercury. But not all people deemed higher risk by traditional methods may need to be aggressively treated McEvoy says. Some people react poorly to higher doses of blood pressure medicines and experience side effects such as sexual dysfunction dizziness falls weakness and more. And the risk factor equations that determine whether certain people are at higher risk and should be treated more intensively with blood pressure medications may have inaccuracies on the individual level says McEvoy. We can predict that about  out of every  people with a particular risk score will die of a heart attack but the equations dont tell us which of those people will be one of the actual  they dont give us personalized information says McEvoy. Conventionally coronary artery calcium scores have informed physicians decisions of whether to put a patient on statins but the researchers say they havent been evaluated before for their potential ability to determine blood pressure treatment. To determine if coronary artery calcium scores could inform blood pressure recommendations too the researchers used data from  participants in the MultiEthnic Study of Atherosclerosis MESA who had systolic blood pressures between  and  millimeters of mercury. Participants were an average of  years old and  percent were men. Thirtyfive percent were white  percent were AfricanAmerican  percent were Hispanic and  percent were ChineseAmerican. At the beginning of the study investigators measured their blood pressure and performed a cardiac CT scan to determine coronary artery calcium scores. They also calculated each participants heart disease risk with the Atherosclerotic Cardiovascular Disease Risk Algorithm which uses traditional risk factors such as race age sex cholesterol levels and family history of disease. About once a year for  years an interviewer contacted each participant or a family member to determine heart disease diagnosis hospitalizations or deaths. After about  years the participants had  heart disease events such as heart attack heart failure stroke and death. The researchers divided the participants by their coronary artery calcium scores into one of three groups those with a score of zero those with a score of one to  and those with a score greater than . Then they looked at the number of heart diseaserelated events in each calcium score category broken down by blood pressure range and calculated heart disease risk. Low heart disease risk was classified as a less than  percent chance of a heart disease event over the next  years and high risk was  percent or greater risk of a heart disease event. To get the event rate the investigators divided the number of events in each category by the amount of people in the study multiplied by the length of time they spent in the study known as a personyear. Participants with calcium scores of zero with a high calculated risk of heart disease had a relatively low actual event rate after the year study. For example according to the researchers those with systolic blood pressures below  millimeters of mercury and no calcium had an event rate of . events per  personyears and similar people with systolic blood pressures between  and  millimeters of mercury had an event rate of . events per  personyears. In contrast participants with systolic blood pressure under  millimeters of mercury  below the current cutoff for treatment  and rated with a low predicted risk of heart disease who had a calcium score over  had a high actual event rate of . events per  personyears. Thus even though their calculated heart disease risk is relatively low and their blood pressure is below traditional cutoffs for treatment the researchers say people in this category with calcium over  are high risk and may benefit from more aggressive blood pressure treatment. Participants with high systolic blood pressure between  and  millimeters of mercury had high event rates ranging from  to  heart disease events per  personyears regardless of their calcium scores. The researchers say this demonstrates that calcium scores may only be useful in guiding more personalized blood pressure treatment for patients with mild high blood pressure  the gray zone  not those with high blood pressure. 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 dont need to be treated aggressively to  millimeters of mercury and can be treated to  instead says McEvoy. But if patients have a high calcium score and are in the gray zone then it would make sense to go with  as a treatment goal. The researchers caution that results are from an observational study and a randomized trial would be needed to confirm the recommendations. Coronary artery calcium scans arent usually covered by insurance and can range in cost from  to . The scans use radiation so there is a very small cancer risk for susceptible individuals. About  million adults in the U.S. have high blood pressure  a systolic blood pressure over  millimeters of mercury  putting them at increased risk for heart attacks stroke heart failure and kidney disease according to the U.S. Centers for Disease Control and Prevention. Additional authors on the study included Seth Martin Zeina Dardari Wendy Post Khurram Nasir and Michael Blaha of Johns Hopkins Michael Miedema of the Minneapolis Heart Institute Veit Sandfort of the National Institutes of Health Joseph Yeboah of Wake Forest Baptist Health Matthew Budoff of the University of California Los Angeles David Goff of the Colorado School of Public Health and Bruce Psaty of the University of Washington. The study was funded by the P.J. Schafer Cardiovascular Research Fund the Johns Hopkins Magic That Matters Research Fund for Cardiovascular Research grants from the National Center for Advancing Translational Sciences ULTR and ULTR and contracts from the National Heart Lung and Blood Institute HHSNI NHC NHC NHC NHC NHC NHC NHC NHC NHC NHC and NHC."