Hypertension in aortic valve stenosis--a Trojan horse

Abstract

Aortic valve stenosis (AS) is the most frequent heart valve disease in the elderly population,1 causing a significant economic burden on Western societies. Many studies have addressed the prevalence of various cardiovascular risk factors in patients with AS, some of them suggesting possible therapeutic strategies to slow down disease progression.2 Among others, arterial hypertension has been shown to be more frequent in patients with AS than in the control populations without relevant valve disease.3 There has been discussion on how arterial hypertension might influence the aortic valve area and the transvalvular pressure gradient. Theoretically, an elevated blood pressure might lead to an increase in the peripheral vascular resistance, a decrease of the vascular compliance, and to changes of the transvalvular flow rate.4 The scientific data published so far are contradictory: while some authors demonstrated a direct influence of blood pressure on the indices of AS severity, others could not prove an independent effect.5–7 In their study, Mascherbauer and colleagues have used a well-controlled in vitro circulation model to assess the influence of a wide range of systolic blood pressure on valve area and transvalvular gradients measured by echocardiography and catheter techniques.8 In their model, pressure gradients as well as valve areas did not change when systemic pressure was raised. Neither valve area nor pressure … *Corresponding author. Tel: +49 621 383 2204, Fax: +49 621 383 3821, Email: jens.kaden{at}med.ma.uni-heidelberg.de