In a cohort study of 5.4 million participants, long-term exposure to high BP was associated with increased risk for aortic valve stenosis and regurgitation, according to data published in the European Heart Journal.
“The study shows that serious valvular heart diseases that are common at old age are not simply due to aging,” Kazem Rahimi, FRCP, DM, MSc, FESC, deputy director and associate professor of cardiovascular medicine at The George Institute for Global Health, University of Oxford, said in a press release. “Long-term exposure to higher blood pressure is a strong and potentially modifiable risk factor for aortic stenosis and regurgitation at every level of typical blood pressure, not only in those who are classified as having hypertension. Blood pressure should be considered as a major risk factor for aortic valve disease, much in the same way as we think of elevated blood pressure as a risk factor for atherosclerotic disease. The study suggests that the associations are causal, but this requires further confirmation.”
Rahimi and colleagues investigated the relationship between high BP, aortic stenosis and aortic regurgitation in a U.K. cohort of 5.4 million adults without known CVD or aortic valve disease at baseline.
During 9.2 years of follow-up, 0.38% of participants were diagnosed with aortic stenosis and 0.12% were diagnosed with aortic regurgitation.
Rahimi and colleagues found that as systolic BP rose, the risk for aortic stenosis and aortic regurgitation increased, and the relationship was continuous starting at 115 mm Hg.
For each 20-mm Hg increase in systolic BP, risk for aortic stenosis rose by 41% (HR = 1.41; 95% CI, 1.38-1.45) and risk for aortic regurgitation rose by 38% (HR = 1.38; 95% CI, 1.31-1.45), according to the researchers.
The relationship was strongest in younger adults but did not vary by sex or BMI.
In addition, the researchers found that each 10-mm Hg increase in diastolic BP conferred a 24% higher risk for aortic stenosis (HR = 1.24; 95% CI, 1.19-1.29), but there was no significant relationship between diastolic BP and aortic regurgitation risk (HR = 1.04; 95% CI, 0.97-1.11).
Rahimi and colleagues also determined that for every 15-mm Hg increase in pulse pressure, risk for aortic stenosis increased by 46% (HR = 1.46; 95% CI, 1.42-1.5) and risk for aortic regurgitation increased by 53% (HR = 1.53; 95% CI, 1.45-1.62).
“The study by Rahimi et al provides the first solid evidence supporting the need for a radical shift in the approach to [aortic valve disease]. Indeed, over the last few years, the research on valvular heart disease has been focused on improving treatment rather than prevention strategies,” Alberto Giannoni, MD, PhD, from Fondazione Toscana Gabriele Monasterio, Pisa, Italy, and Stefano Masi, MD, PhD, from the department of clinical and experimental medicine at the University of Pisa, wrote in a related editorial. “The findings provided by Rahimi et al might be considered the first step towards a change in the management of [aortic valve disease] and are likely to influence future clinical trials and guidelines. Current European guidelines for the management of arterial hypertension do not consider [aortic valve disease] as manifestations of heart damage related to hypertension and, consequently, do not suggest accurate assessment of aortic valve function and structure in patients with arterial hypertension. Also, they might stimulate new lines of research, particularly imaging studies, with the scope of identifying early alterations of the aortic valve in patients with hypertension that might be highly predictive of future [aortic valve disease].” – by Erik Swain
Disclosures: The authors, Giannoni and Masi report no relevant financial disclosures.