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Hypertension and Risk of Aortic Valve Disease
Study Questions:
Is elevated blood pressure (BP) a risk factor for aortic stenosis (AS) and aortic regurgitation (AR)?
Methods:
This cohort study examined the relationship between BP and aortic valve disease in 5.4 million patients followed in general practice clinics in the United Kingdom without known cardiovascular disease or aortic valve disease, and without treatment using antihypertensive or lipid-lowering medications.
Results:
During a median follow-up of 9.2 years, 0.4% and 0.1% of patients were diagnosed with AS and AR, respectively. Increased systolic BP (SBP) was associated with increased AS and AR. For every 20 mm Hg increase in SBP, there was increased risk of AS (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.31-1.45) and AR (HR, 1.38; 95% CI, 1.31-1.45). For every 10 mm Hg increase in diastolic BP, there was increased risk of AS (HR, 1.24; 95% CI, 1.19-1.29), but not AR.
Conclusions:
Long-term elevation in BP is associated with an increased risk of AS and AR.
Perspective:
There has been a lack of data to support strategies for prevention of aortic valve disease, despite its high and increasing prevalence. This is the first large study to suggest a possible relationship between higher BP and increased incidence of aortic valve disease. For each incremental increase in SBP, there was a marked increase in the rate of both AS and AR, while greater diastolic BP was associated with an increase in AS, but not AR. These findings cannot establish a causal relationship, and it is certainly possible that patient characteristics that resulted in elevated BP also resulted in greater aortic valve disease. Nevertheless, these results should prompt future trials to evaluate whether improved BP control or prevention of elevated BP through lifestyle modifications can reduce the incidence of aortic valve disease.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Lipid Metabolism, Interventions and Structural Heart Disease, Hypertension
Keywords: Antihypertensive Agents, Aortic Valve Insufficiency, Aortic Valve Stenosis, Blood Pressure, Cardiac Surgical Procedures, General Practice, Geriatrics, Heart Defects, Congenital, Heart Valve Diseases, Hypertension, Lipids, Primary Prevention, Risk Factors
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