Elevated blood pressure and risk of aortic valve disease: a cohort analysis of 5.4 million UK adults

Abstract

AimsTo test two related hypotheses that elevated blood pressure (BP) is a risk factor for aortic valve stenosis (AS) or regurgitation (AR).Methods and resultsIn this cohort study of 5.4 million UK patients with no known cardiovascular disease or aortic valve disease at baseline, we investigated the relationship between BP and risk of incident AS and AR using multivariable-adjusted Cox regression models. Over a median follow-up of 9.2 years, 20 680 patients (0.38%) were diagnosed with AS and 6440 (0.12%) patients with AR. Systolic BP (SBP) was continuously related to the risk of AS and AR with no evidence of a nadir down to 115 mmHg. Each 20 mmHg increment in SBP was associated with a 41% higher risk of AS (hazard ratio 1.41, 95% confidence interval 1.38–1.45) and a 38% higher risk of AR (1.38, 1.31–1.45). Associations were stronger in younger patients but with no strong evidence for interaction by gender or body mass index. Each 10 mmHg increment in diastolic BP was associated with a 24% higher risk of AS (1.24, 1.19–1.29) but not AR (1.04, 0.97–1.11). Each 15 mmHg increment in pulse pressure was associated with a 46% greater risk of AS (1.46, 1.42–1.50) and a 53% higher risk of AR (1.53, 1.45–1.62).ConclusionLong-term exposure to elevated BP across its whole spectrum was associated with increased risk of AS and AR. The possible causal nature of the observed associations warrants further investigation.

Systolic Blood Pressure and Risk of Valvular Heart Disease

“…In 2 large-scale studies that used data from electronic health records with BP as a continuous variable as in our study, over a median of 9 years' follow-up, exposure to 20-mm Hg higher BP was associated with a 41% greater risk of aortic stenosis, 38% greater risk of aortic regurgitation, and 26% greater risk of mitral regurgitation. 10,12 Our estimates are stronger than those reported in those large cohort studies. This difference might be related to residual confounding in earlier studies, which can bias associations toward the null.…”

Evaluation of Mitral and Aortic Valvular Disease and Left Ventricular Dysfunction in a Lebanese Population: Retrospective Single-Center Experience

“…A literature review revealed a higher incidence of systemic hypertension in patients with MS [ 25 ] but provided no explanation for it; the etiology could be the subject of a future prospective study aimed at investigating a possible causal relationship. Indeed, blood pressure elevation recently has been investigated as a risk factor for development of AS or AR [ 26 ]. We also found a significant relationship between TR and DM, which has not been described before.…”

Role of p38 MAPK in Atherosclerosis and Aortic Valve Sclerosis

“…Aortic valve sclerosis, or calcific aortic valve disease (CAVD), is an early stage of AVS and is marked by thickening and calcification of the valve tissue. Common risk factors to develop aortic valve sclerosis are high blood pressure, high blood lipid and cholesterol levels, obesity, diabetes mellitus, smoking, and chronic kidney disease [6,7,8,9,10,11]. The healthy human aortic valve is composed of three thin leaflets (<1 mm), each made up of three layers—the fibrosa on the aortic side, the spongiosa, and the ventricularis on the ventricular side of the valve (Figure 1; upper left).…”