EFFECTS OF HYPERTENSION ON TAVI OUTCOMES

Abstract

Objective: Severe aortic stenosis (AS) is the most common valvular disease in elderly and transcatheter aortic valve implantation (TAVI) is the standard of care treatment for AS in patients with high surgical risk. Hypertension accompanies with AS in this population in general. We aimed to evaluate the impact of hypertension on TAVI related outcomes. Design and method: All of the patients who underwent TAVI procedure between January 2010 and March 2020 were screened and patients with eligible datas were included. Datas were obtained from hospital electronic database. Results: A total of 306 cases were enrolled. Mean age of the population was 76.0 ± 10.4 61.4% of the cases were female. Median follow-up was 28.4 (13.0-49.5) months. Age was significantly higher (77.0 ±8.2 vs. 72.7± 14.8; p = 0.018) and diabetes was more frequent (37.6% vs. 16.9%; p = 0.001) in hypertensive patients. Use of RAS blockers (62.0% vs 28.6%; p<0.001) and calcium channel blockers (34.5% vs. 3.9%; p<0.001) were more frequent in hypertensive cases as expected. Baseline characteristics and outcomes were summarized in Table-1. Left ventricular mass index was similar between the two groups (129.5 ± 32.8 vs. 132.7 ± 39.3; p = 0.502). Rates of contrast induced nephropathy, insertion site complications and need of de novo pacemaker implantation due to advanced heart block were not different between the two arms. Stroke rates were distinctly higher in patients with hypertension (7.4% vs 0%; p = 0.009), while all-cause mortality during follow-up was similar between patients with and without hypertension. Conclusions: Left ventricular mass index increases in patients with severe AS and hypertension also leads left ventricular hypertrophy by raising afterload. However, LVMI values were similar between patients with and without hypertension contrary to as expected. Higher proportion of RAS blocker use that has favorable effects on cardiac remodelling can explain this finding. Significantly increased risk of stroke in patients with hypertension is another attractive finding that should be kept in mind.