Hypertension in aortic stenosis: a systematic review

Abstract

Aims:To establish the effect of idiopathic arterial hypertension (HT) on LV function, geometry and remodelling in the setting of aortic stenosis (AS) and its impact on prognosis and outcomes. In addition we evaluated the efficacy and safety of anti-HT agents in patients with moderate to severe AS. Methods: A search was performed in the Cochrane, Pubmed and Embase databases using the MESH or Entree terms “aortic valve stenosis”, “hypertension”, “blood pressure”, “ventricular function”, “ventricular dysfunction”, “prognosis”, “mortality” and “symptoms”, and 1156 articles were reviewed. Key demographics and outcomes of patients in 82 suitable studies were performed. Results: Patients with concurrent AS and arterial HT had worse degrees of LV hypertrophy effect size 0.33 p value= 0.05 and systolic function effect size 0.0 p= 0.01 using Cohen’s method compared to their normotensive counterparts. They experienced more rapid development of symptoms effect size 0.076 p> 0.05 and greater degrees of diastolic dysfunction effect size 0.28 p=0.05. HT post aortic valve replacement impaired reverse LV remodelling and is associated with a poorer outcome. Appropriate antihypertensive agents are well tolerated and beneficial in the setting of AS. Conclusion: HT in moderate to severe AS resulted in worsening LV hypertrophy and more rapid development of symptoms.