High blood pressure linked to aortic valve disease

Turns out, people with a long-term problem of blood pressure has an increased risk of aortic valve disease (AVD) - problems with the valve that controls how blood is pumped from the left ventricle of the heart out into the main artery, the aorta.

In a recent study conducted by European Society of Cardiology, researchers found that above a systolic blood pressure of 115 mmHg, every additional 20 mmHg was associated with a 41 percent higher risk of aortic stenosis (AS) and a 38 percent higher risk of aortic regurgitation (AR) later in life. Compared to people who had a systolic blood pressure of 120 mmHg or lower, those with a systolic blood pressure of 161 mmHg or higher had more than twice the risk of being diagnosed with AS and were nearly twice as likely to be diagnosed with AR during follow-up.

The findings suggest that controlling blood pressure, even at levels below the threshold currently defined for hypertension of 140/90 mmHg, may be a way to prevent these conditions.

AS is a condition in which the valve that opens and closes when blood is pumped out of the left ventricle becomes narrowed and stiff due to calcium building up. When this happens, the valve fails to work effectively, making it harder for the heart to pump blood to the rest of the body. AR occurs when the valve doesn't close properly, allowing some blood to leak back into the left ventricle.

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

The patients included in this analysis were aged between 30 and 90 years, and none had any known heart or blood vessel diseases at the time of their earliest blood pressure measurement.

An average of nearly seven blood pressure measurements per patient was taken during the study period, which helped to estimate the patient's actual blood pressure better. The ability to collect data over a long period of time, combined with a large number of patients, makes this the first study substantial enough to investigate the link between blood pressure and aortic valve disease and how it changes with age and with different blood pressure levels.

The study shows that serious valvular heart diseases that are common in old age are not simply due to aging. Long-term exposure to higher blood pressure is a strong and potentially modifiable risk factor for aortic stenosis and regurgitation at every level of typical blood pressure, not only in those who are classified as having hypertension.

Blood pressure should be considered as a major risk factor for aortic valve disease, much in the same way as we think of elevated blood pressure as a risk factor for atherosclerotic disease. It suggests that the associations are causal, but this requires further confirmation.

The findings appeared in the Journal of European Heart.