Hypertension identified as risk factor for aortic valve disease
Sustained elevated blood pressure (BP) can increase a patient’s risk for both aortic valve stenosis (AS) and aortic regurgitation (AR), according to an analysis of 5.4 million non-CVD patients in the U.K.
Kazem Rahimi, DM, MSc, a professor at the University of Oxford and deputy director of the university’s George Institute for Global Health, led the study, which evaluated two hypotheses that hypertension is a risk factor for aortic valve disease. His team’s work was published in the Sept. 12 edition of the European Heart Journal.
“Despite growing prevalence, modifiable causes of aortic valve disease are not well-understood, and consequently, there are no effective approaches to its prevention,” Rahimi and co-authors wrote in EHJ. “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 BP, on the risk of aortic valve disease.”
There’s little linking the two in existing medical literature, the authors said, but some trials have shown high blood pressure implements tensile stress on aortic leaflets, possibly contributing to endothelial injury or disruption. Some cross-sectional studies have also reported a positive correlation between hypertension and risk for AS and AR.
Rahimi and his colleagues took a large-scale approach for their research, investigating the relationship between BP and risk of incident AS and AR in a population of 5.4 million British residents. None of the participants had existing cardiac disease or valve complications ahead of the study, but over the course of nine years, 20,680 patients developed AS and 6,440 patients were diagnosed with AR.
Systolic BP was consistently related to the risk of aortic valve disease, the authors reported—each 20 mmHg bump in systolic BP was linked to a 41 percent higher risk of AS and a 38 percent higher risk of AR. Every 10 mmHg increase in diastolic BP was associated with a 24 percent increased risk of AS, but not AR.
“The continuous log-linear relationships between systolic BP and risk of aortic valve disease observed in our study are consistent with other large-scale epidemiological studies that have examined associations with other vascular outcomes,” Rahimi et al. said. “These findings collectively suggest that AS and AR might be partially preventable with potential implications on clinical practice guidelines for prevention of cardiovascular disease in general and valvular heart disease and hypertension in particular.”
The authors said the relationship between BP and aortic valve disease was stronger in younger patients, but body mass index and sex didn’t seem to have any bearing on the study’s results.
“These findings suggest that risk of aortic valve disease might be modifiable, but further research, ideally from meta-analyses of BP-lowering trials or Mendelian randomization studies, are needed to assess the causal nature of the observed associations,” they wrote.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.