Hypertension in aortic stenosis: implications for left ventricular structure and cardiovascular events.
The impact of hypertension on left ventricular structure and outcome during progression of aortic valve stenosis has not been reported from a large prospective study. 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/height(2.7) ≥ 46.7 g/m(2.7) in women and ≥ 49.2 g/m(2.7) 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. In conclusion, 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.
Institute of Medicine, University of Bergen, 5021 Bergen, Norway.   ashild.rieck@gmail.com.
Åshild E
ÅE
Rieck
Dana
D
Cramariuc
Kurt
K
Boman
Christa
C
Gohlke-Bärwolf
Eva M
EM
Staal
Mai Tone
MT
Lønnebakken
Anne B
AB
Rossebø
Eva
E
Gerdts
D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000150:complications / Q000188:drug therapy*; D001384:Azetidines / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D004359:Drug Therapy, Combination; D004452:Echocardiography; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use*
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D001384:Azetidines; D019821:Simvastatin; D000069438:Ezetimibe