Elevated blood pressure and risk of aortic valve disease: a cohort analysis of 5.4 million UK adults.

Kazem Rahimi,Amit Kiran,Mark Woodward,Fatemeh Rahimian,Catherine M Otto,Milad Nazarzadeh,Hamid Mohseni,Terence Dwyer,Stephen Macmahon,Jenny Tran

doi:10.1093/eurheartj/ehy486

Abstract

AimsTo test two related hypotheses that elevated blood pressure (BP) is a risk factor for aortic valve stenosis (AS) or regurgitation (AR).Methods and resultsIn this cohort study of 5.4 million UK patients with no known cardiovascular disease or aortic valve disease at baseline, we investigated the relationship between BP and risk of incident AS and AR using multivariable-adjusted Cox regression models. Over a median follow-up of 9.2 years, 20 680 patients (0.38%) were diagnosed with AS and 6440 (0.12%) patients with AR. Systolic BP (SBP) was continuously related to the risk of AS and AR with no evidence of a nadir down to 115 mmHg. Each 20 mmHg increment in SBP was associated with a 41% higher risk of AS (hazard ratio 1.41, 95% confidence interval 1.38–1.45) and a 38% higher risk of AR (1.38, 1.31–1.45). Associations were stronger in younger patients but with no strong evidence for interaction by gender or body mass index. Each 10 mmHg increment in diastolic BP was associated with a 24% higher risk of AS (1.24, 1.19–1.29) but not AR (1.04, 0.97–1.11). Each 15 mmHg increment in pulse pressure was associated with a 46% greater risk of AS (1.46, 1.42–1.50) and a 53% higher risk of AR (1.53, 1.45–1.62).ConclusionLong-term exposure to elevated BP across its whole spectrum was associated with increased risk of AS and AR. The possible causal nature of the observed associations warrants further investigation.

Highlights

IntroductionDespite growing prevalence[1,2] modifiable causes of aortic valve disease (stenosis or regurgitation) are not well understood, and there are no effective approaches to its prevention
Despite growing prevalence[1,2] modifiable causes of aortic valve disease are not well understood, and there are no effective approaches to its prevention
See page 3604 for the editorial comment on this article. In this cohort study of 5.4 million UK patients with no known cardiovascular disease or aortic valve disease at baseand results line, we investigated the relationship between blood pressure (BP) and risk of incident aortic stenosis (AS) and aortic regurgitation (AR) using multivariable-adjusted Cox regression models

Summary

Introduction

Despite growing prevalence[1,2] modifiable causes of aortic valve disease (stenosis or regurgitation) are not well understood, and there are no effective approaches to its prevention. Given the shared pathways between several cardiovascular conditions, there has been some interest in assessment of the effect of established cardiovascular risk factors, such as elevated blood pressure (BP), on the risk of aortic valve disease.[3,4,5] Mechanistic evidence for the potential causal role of BP comes from studies showing that hypertension causes abnormally high tensile stress on aortic leaflets, which can lead to endothelial injury or disruption.[6,7] Supporting clinical evidence for the potential role of elevated BP and risk of aortic valve disease comes from a few largely cross-sectional studies that have reported a positive association between hypertension and risk of aortic stenosis (AS)[8,9,10] or aortic regurgitation (AR).[11] to our knowledge, no large-scale.

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