Hypertension, aortic stenosis, and aortic regurgitation

The prevalence of hypertension (1) and of valvular aortic stenosis (2) increase with age, and both hypertension (3,4) and valvular aortic stenosis (5) cause left ventricular hypertrophy. Both hypertension (1,3) and valvular aortic stenosis (2,6) are also associated with an increased incidence of cardiovascular events and mortality. Hypertension (either a systolic blood pressure of 140 mmHg and higher or a diastolic blood pressure of 90 mmHg and higher) was present in 132 of 180 persons (73%), mean age 82 years, with mild valvular aortic stenosis (7), in 1,238 of 1,720 persons (72%), mean age 67 years, with asymptomatic mild-to-moderate valvular aortic stenosis (8), and in 153 of 225 patients (68%), mean age 68 years, with severe valvular aortic stenosis (9). Hypertension is a risk factor for aortic stenosis (7,10,11) and is associated with progression of aortic stenosis (7). Hypertension is also associated with aortic valve calcification (10-13). In a study of 3.39 million hospital discharges in Ireland, hypertension was associated with aortic stenosis with an odds ratio of 4.0 (14). At 4.3-year follow-up of 1,656 patients, mean age 67 years, with asymptomatic mild-to-moderate valvular aortic stenosis, in Cox regression analyses, each 15 g/m higher baseline left ventricular mass index predicted increases of 12% for major cardiovascular events, of 28% for ischemic cardiovascular events, of 34% for cardiovascular mortality, and of 23% for combined total mortality and hospitalization for heart failure independent of confounders (15). A progressive increase in left ventricular mass index during follow-up of each 15 g/m increase was consistently associated with a 13% to 61% increase in cardiovascular events independent of other variables (15).