P450Impact of hypertension on progression of left ventricular hypertrophy and cardiovascular events in patients with aortic valve stenosis.


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Abstract

Background: Hypertension is commonly found to coexist with aortic stenosis (AS). However, less is known about how this comorbidity influences left ventricular (LV) structure and outcome in these patients.Methods: Clinical, echocardiographical and data on the secondary study endpoint ischemic cardiovascular events and subgroups were collected from annual study visits during an average of 45.8 months follow-up in 1728 patients with initial asymptomatic AS randomised in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS). Hypertension was defined as elevated blood pressure (≥140/90) at baseline visit or known hypertension. LV geometry was assessed from LV mass indexed to height^2.7 and relative wall thickness in combination.Results: Compared to normotensive patients (NT, n=235), the hypertensive (HT, n=1493) group had significantly higher age, body mass index, blood pressure and LV mass at baseline (all p<0.05). Baseline and in-study change in peak aortic jet velocity did not differ between groups. LV geometry changed from predominantly normal geometry, to predominantly concentric LV hypertrophy at final visit in both groups, but HT patients had significantly higher prevalence of LV hypertrophy both at baseline (38 % vs 25 %, p<0.01) and at last study visit (60 % vs 51 %,p<0.01) In multivariate Cox regression, HT predicted higher rate of ischemic cardiovascular events (Table).Conclusion: In AS, concomitant HT is associated with more abnormal LV geometry and an increased rate of ischemic cardiovascular events.

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