Antihypertensive Treatment With β-Blockade in Patients With Asymptomatic Aortic Stenosis and Association With Cardiovascular Events

Casper N Bang, Anders M Greve, Anne B Rossebø, Simon Ray, Kenneth Egstrup, Kurt Boman, Christoph Nienaber, Peter M Okin, Richard B Devereux, Kristian Wachtell, Casper N Bang, Anders M Greve, Anne B Rossebø, Simon Ray, Kenneth Egstrup, Kurt Boman, Christoph Nienaber, Peter M Okin, Richard B Devereux, Kristian Wachtell

Abstract

Background: Patients with aortic stenosis (AS) often have concomitant hypertension. Antihypertensive treatment with a β-blocker (Bbl) is frequently avoided because of fear of depression of left ventricular function. However, it remains unclear whether antihypertensive treatment with a Bbl is associated with increased risk of cardiovascular events in patients with asymptomatic mild to moderate AS.

Methods and results: We did a post hoc analysis of 1873 asymptomatic patients with mild to moderate AS and preserved left ventricular ejection fraction in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. Propensity-matched Cox regression and competing risk analyses were used to assess risk ratios for all-cause mortality, sudden cardiac death, and cardiovascular death. A total of 932 (50%) patients received Bbl at baseline. During a median follow-up of 4.3±0.9 years, 545 underwent aortic valve replacement, and 205 died; of those, 101 were cardiovascular deaths, including 40 sudden cardiovascular deaths. In adjusted analyses, Bbl use was associated with lower risk of all-cause mortality (hazard ratio 0.5, 95% confidence interval 0.3-0.7, P<0.001), cardiovascular death (hazard ratio 0.4, 95% confidence interval 0.2-0.7, P<0.001), and sudden cardiac death (hazard ratio 0.2, 95% confidence interval 0.1-0.6, P=0.004). This was confirmed in competing risk analyses (all P<0.004). No interaction was detected with AS severity (all P>0.1).

Conclusions: In post hoc analyses Bbl therapy did not increase the risk of all-cause mortality, sudden cardiac death, or cardiovascular death in patients with asymptomatic mild to moderate AS. A prospective study may be warranted to determine if Bbl therapy is in fact beneficial.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.

Keywords: aortic valve stenosis; arrhythmia (heart rhythm disorders); atrial fibrillation; high blood pressure; hypertension; β‐blocker.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
In‐treatment systolic blood pressure and confidence intervals according to β‐blockade.
Figure 2
Figure 2
Kaplan‐Meier plot for all‐cause mortality in the propensity‐matched subset.

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