HYPERTENSION IN AORTIC STENOSIS

Abstract

Objective: The impact of hypertension on symptoms and functional capacity during exercise treadmill test (ETT) in apparently asymptomatic patients with aortic stenosis (AS) is poorly understood.Design and method: 314 patients (age 65 ± 12 years, 68% men) with moderate or severe asymptomatic AS underwent baseline echocardiography and ETT. Hypertension was defined from a history of elevated blood pressure (BP) values, past or current treatment with antihypertensive agents or a BP at the baseline clinic visit >140/90 mmHg. Results: Hypertensive patients (73%) were older, more likely to have diabetes, hypercholesterolemia and coronary artery disease, larger left atrial diameters, higher LV mass, and a higher proportion of LV hypertrophy than normotensive patients (Figure). In the univariate logistic regression analyses, hypertension or clinic systolic BP had no association with revealed symptoms. In a multivariate logistic regression analysis after adjustment for age, obesity, and LV ejection fraction, a smaller aortic valve area had a borderline association with revealed symptoms (OR 5.86;95% CI 0.95–32.25, p = 0.056), but a rapid early rise in heart rate was identified as a powerful predictor of revealed symptoms (OR 14.76;95%CI 6.23–34.99, p < 0.001). In the same model a lower peak systolic BP during ETT was associated with revealed symptoms (OR 1.02;95% CI 1.01–1.04, p = 0.011). After adjustment for age, gender and body mass index, hypertension did not retain its association with lower METs (beta = −0.06, p = 0.311). Conclusions: Hypertension in AS patients was associated with a high cardiovascular disease burden, but did not interact with symptoms or functional capacity during ETT. Hypertension does not interfere with the clinical interpretation of exercise testing.