High blood pressure is linked to increased risk of aortic valve disease

In a study of 5.4 million adults in the United Kingdom, published in the European Heart Journal Today (Thursday), researchers found that beyond a systolic blood pressure of 115 mmHg, each additional 20 mmHg was associated with a risk of aortic stenosis (SA) greater than 41. % and a 38% higher risk of aortic regurgitation (AR). Compared to people with systolic blood pressure less than or equal to 120 mmHg, people with systolic blood pressure of 161 mmHg or higher were more than twice as likely to have AS and were almost twice as likely to have 39, be diagnosed at the top

The results suggest that control of blood pressure, even at levels below the currently defined threshold for hypertension of 140/90 mmHg, could be a way to prevent these conditions. "These findings collectively suggest that AS and AR could be partially avoided with potential implications on clinical practice guidelines for the prevention of cardiovascular disease in general and valvular heart disease and hypertension." in particular, "write the authors of the EHJ document.

AS is a condition in which the valve that opens and closes when blood is pumped from the left ventricle becomes narrower and stiffer due to calcium buildup. When this happens, the valve does not work properly, making it more difficult to pump blood to the rest of the body. AR occurs when the valve does not close properly, allowing the blood to return to the left ventricle.

During an average follow-up period of more than nine years, 20,680 (0.38%) of the 5.4 million patients in the study were diagnosed with AS alone and 6440 (0.12 %) were diagnosed alone. The average age at diagnosis was 64 years and 57 years for AS and AR respectively.

The researchers, led by Kazem Rahimi, deputy director and associate professor of cardiovascular medicine at the George Institute for Global Health, University of Oxford, UK, analyzed data from electronic health records from January 1990 to December 2015 The CPRD database contains anonymous patient data from 674 general practices in the UK. The patients included in this analysis were 30 to 90 years old and none had known cardiac or vascular disease at the time of their first blood pressure measurement.

An average of nearly seven blood pressure measurements per patient was taken during the study period, which allowed to estimate the actual blood pressure of the patient. The ability to collect data over a long period, combined with the large number of patients, makes it the first study of sufficient importance to study the relationship between blood pressure and aortic valve disease and its evolution with age and blood pressure. .

Professor Rahimi said, "The study shows that serious heart valve diseases that are common in the elderly are not simply due to aging.Long-term exposure to high blood pressure is a significant risk factor for Aortic stenosis and regurgitation of typical blood pressure, not only in those who are classified as suffering from high blood pressure, blood pressure should be considered a major risk factor for aortic valve disease, just as one thinks of high blood pressure as a risk factor for atherosclerotic disease The study suggests that associations are causal, but this requires further confirmation. "

Previous research has suggested that the mechanism involved in the link between blood pressure and abortion disease could be that higher blood pressure could damage cells, resulting in a loss of elasticity. the aorta and a stiffening of the aortic valve.

The limitations of the study include the possibility that an increase in blood pressure is an indication of an underlying problem with arterial stiffness caused by something else. To explore this issue further, researchers are conducting a study that uses genetic indicators for higher blood pressure that are unaffected by environmental factors. Another limitation is the use of data from a general practice registry, which could be prone to errors in the measurement of blood pressure, other factors that may affect the results and results. results for patients.

In an editorial accompanying the research paper, Dr. Stefano Masi of the Department of Clinical and Experimental Medicine, University of Pisa (Italy), and Dr. Alberto Giannoni of the Fondazione Toscana Gabriele Monasterio, Pisa, who did not participate in the research, write that the study "provides the first solid evidence to support the need for a radical change in the approach of the DSA. In fact, in recent years , valvular heart disease research has focused on improving treatments rather than prevention strategies … Thus, the results provided by Rahimi et al could be considered as the first step towards a change in the management of AVM and likely to influence future clinical studies and guidelines, cardiac lesions related to hypertension and, therefore, do not suggest an accurate assessment of the Function and structure of the aortic valve in patients with high blood pressure disruption. In addition, they could stimulate new lines of research, particularly imaging studies, with the goal of identifying early alterations of the aortic valve in patients with hypertension that may be highly predictive. of a future AVD ".

The proportion of people living with AS is estimated at about 0.4% of the population in the United States, although the prevalence increases with age; In the United States, 0.02% of 18-44 year olds have AS, but 2.8% of those aged 75 and over have AS. For the AR, the corresponding prevalence in these age groups is estimated at 0.2% and 2% respectively, and the prevalence of AS and RA is similar in Europe . The number of people diagnosed with severe aortic valve disease has increased steadily in recent years and is expected to continue as populations age.

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More information:
European Heart Journal (2018). DOI: 10.1093 / eurheartj / ehy486