Hypertension in Aortic Stenosis
Rieck AE et al. – Among patients with initial asymptomatic mild–to–moderate aortic stenosis, hypertension was associated with more abnormal left ventricular structure and increased cardiovascular morbidity and mortality.Methods
- Data from 1616 patients with asymptomatic aortic stenosis randomized to placebo–controlled treatment with combined simvastatin and ezetimibe in the Simvastatin Ezetimibe in Aortic Stenosis Study were used.
- The primary study end point included combined cardiovascular death, aortic valve events, and ischemic cardiovascular events.
- > Hypertension was defined as history of hypertension or elevated baseline blood pressure.
- Left ventricular hypertrophy was defined as left ventricular mass/height2.7 ≥ 46.7 g/m2.7 in women and ≥ 49.2 g/m2.7 in men and concentric geometry as relative wall thickness ≥ 0.43.
- Baseline peak aortic jet velocity and aortic stenosis progression rate did not differ between hypertensive (n=1340) and normotensive (n=276) patients.
- During 4.3 years of follow–up, the prevalence of concentric left ventricular hypertrophy increased 3 times in both groups.
- Hypertension predicted 51% higher incidence of abnormal LV geometry at final study visit independent of other confounders (P<0.01).
- In time–varying Cox regression, hypertension did not predict increased rate of the primary study end point.
- However, hypertension was associated with a 56% higher rate of ischemic cardiovascular events and a 2–fold increased mortality (both P<0.01), independent of aortic stenosis severity, abnormal left ventricular geometry, in–treatment systolic blood pressure, and randomized study treatment.
- No impact on aortic valve replacement was found.