Hypertension in aortic stenosis: relationship with revealed symptoms and functional measures on treadmill exercise.

Abstract

BACKGROUND:

The impact of hypertension on symptoms and functional capacity during exercise treadmill test (ETT) in apparently asymptomatic patients with aortic stenosis is poorly understood.

METHODS:

A total of 314 patients (age 65 ± 12 years, 68% men) with moderate or severe asymptomatic aortic stenosis underwent baseline echocardiography and ETT. Hypertension was defined as a history of elevated blood pressure (BP), past or current treatment with antihypertensive agents or a BP at the baseline clinic visit more than 140/90 mmHg.

RESULTS:

There were 229 (73%) patients with hypertension who were older, more likely to have diabetes, hypercholesterolemia and coronary artery disease, larger left atrial diameters, higher left ventricular (LV) mass and a higher proportion of LV hypertrophy than normotensive patients. In a univariate logistic regression analysis hypertension and clinic SBP were not associated with revealed symptoms. In a multivariate logistic regression analysis, lower peak SBP [odds ratio (OR) 1.02;95% confidence interval (CI) 1.00-1.04, P = 0.017] and rapid early rise in heart rate (OR 15.03; 95% CI 6.23-36.24, P < 0.001) were associated with a higher risk of revealed symptoms while the use of antihypertensive treatment was associated with a lower risk of revealed symptoms (OR 0.40; 95% CI 0.18-0.89, P = 0.025), independent of age, obesity, LV ejection fraction and aortic valve area. In a linear regression analysis, after adjustment for age, sex and BMI, hypertension did not retain an association with lower metabolic equivalents (β = -0.06, P = 0.311).

CONCLUSION:

Hypertension in aortic stenosis patients was associated with a high cardiovascular disease burden, but did not interact with symptoms or functional capacity during ETT. Hypertension does not interfere with the clinical interpretation of exercise testing.

• Authors: Sahrai Saeed, Giuseppe Mancia, Ronak Rajani, Denise Parkin, John B Chambers
• Journal: Journal of hypertension (J Hypertens) Vol. 37 Issue 11 Pg. 2209-2215 (11 2019) ISSN: 1473-5598 [Electronic] Netherlands
• PMID: 31157741 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents

Topics

• Aged
• Antihypertensive Agents (therapeutic use)
• Aortic Valve Stenosis (complications, physiopathology)
• Blood Pressure (physiology)
• Echocardiography
• Exercise (physiology)
• Exercise Test
• Exercise Tolerance
• Female
• Heart Atria (diagnostic imaging)
• Humans
• Hypertension (complications, drug therapy, physiopathology)
• Hypertrophy, Left Ventricular
• Logistic Models
• Male
• Middle Aged
• Obesity (complications)
• Retrospective Studies
• Stroke Volume
• Ventricular Function, Left