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Assessing optimal blood pressure in patients with asymptomatic aortic valve stenosis

Nielsen, Olav W.; Sajadieh, Ahmad; Sabbah, Muhammad; Greve, Anders M.; Olsen, Michael H.; Boman, Kurt; Nienaber, Christoph A.; Kesäniemi, Y. Antero; Pedersen, Terje R. and Willenheimer, Ronnie LU , et al. (2016) In Circulation 134(6). p.455-468
Abstract

Background: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal. Methods: A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate. Results: The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95%... (More)

Background: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal. Methods: A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate. Results: The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95% confidence interval [CI], 3.1-6.0) and lowest for average systolic BP of 120 to 139 mm Hg (2.0 per 100 person-years; 95% CI, 1.6-2.6). In multivariable analysis, all-cause mortality was associated with average systolic BP <120 mm Hg (hazard ratio [HR], 3.4; 95% CI, 1.9-6.1), diastolic BP ≥90 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), and pulse pressure <50 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), with systolic BP of 120 to 139 mm Hg, diastolic BP of 70 to 79 mm Hg, and pulse pressure of 60 to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0.039). Conclusions: Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.

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publishing date
type
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publication status
published
subject
keywords
aortic valve stenosis, blood pressure, hypertension, mortality, prognosis
in
Circulation
volume
134
issue
6
pages
14 pages
publisher
Lippincott Williams and Wilkins
external identifiers
  • scopus:85000631199
ISSN
0009-7322
DOI
10.1161/CIRCULATIONAHA.115.021213
language
English
LU publication?
no
id
fc0dc818-b12d-405f-a66b-13c0d7d3a303
date added to LUP
2016-12-29 13:06:59
date last changed
2017-09-17 09:35:50
@article{fc0dc818-b12d-405f-a66b-13c0d7d3a303,
  abstract     = {<p>Background: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal. Methods: A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate. Results: The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95% confidence interval [CI], 3.1-6.0) and lowest for average systolic BP of 120 to 139 mm Hg (2.0 per 100 person-years; 95% CI, 1.6-2.6). In multivariable analysis, all-cause mortality was associated with average systolic BP &lt;120 mm Hg (hazard ratio [HR], 3.4; 95% CI, 1.9-6.1), diastolic BP ≥90 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), and pulse pressure &lt;50 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), with systolic BP of 120 to 139 mm Hg, diastolic BP of 70 to 79 mm Hg, and pulse pressure of 60 to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0.039). Conclusions: Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.</p>},
  author       = {Nielsen, Olav W. and Sajadieh, Ahmad and Sabbah, Muhammad and Greve, Anders M. and Olsen, Michael H. and Boman, Kurt and Nienaber, Christoph A. and Kesäniemi, Y. Antero and Pedersen, Terje R. and Willenheimer, Ronnie and Wachtell, Kristian},
  issn         = {0009-7322},
  keyword      = {aortic valve stenosis,blood pressure,hypertension,mortality,prognosis},
  language     = {eng},
  month        = {08},
  number       = {6},
  pages        = {455--468},
  publisher    = {Lippincott Williams and Wilkins},
  series       = {Circulation},
  title        = {Assessing optimal blood pressure in patients with asymptomatic aortic valve stenosis},
  url          = {http://dx.doi.org/10.1161/CIRCULATIONAHA.115.021213},
  volume       = {134},
  year         = {2016},
}