Systolic hypertension and progression of aortic valve calcification in patients with aortic stenosis: results from the PROGRESSA study

Abstract

Aims: Hypertension is highly prevalent in patients with aortic stenosis (AS) and is associated with worse outcomes. The current prospective study assessed the impact of systolic hypertension (SHPT) on the progression of aortic valve calcification (AVC) measured by multidetector computed tomography (MDCT) in patients with AS.

Methods and results: The present analysis includes the first series of 101 patients with AS prospectively recruited in the PROGRESSA study. Patients underwent comprehensive Doppler echocardiography and MDCT exams at baseline and after 2-year follow-up. AVC and coronary artery calcification (CAC) were measured using the Agatston method. Patients with SHPT at baseline (i.e. systolic blood pressure ≥140 mmHg; n = 37, 37%) had faster 2-year AVC progression compared with those without SHPT (i.e. systolic blood pressure <140 mmHg) (AVC median [25th percentile-75th percentile]: +370 [126-824] vs. +157 [58-303] AU; P = 0.007, respectively). Similar results were obtained with the analysis of AVC progression divided by the cross-sectional area of the aortic annulus (AVCdensity: +96 [34-218] vs. +45 [14-82] AU/cm2, P = 0.01, respectively). In multivariable analysis, SHPT remained significantly associated with faster progression of AVC or AVCdensity (all P = 0.001). There was no significant difference between groups with respect to progression of CAC (+39 [3-199] vs. +41 [0-156] AU, P = 0.88).

Conclusion: This prospective study shows for the first time that SHPT is associated with faster AVC progression but not with CAC progression in AS patients. These findings provide further support for the elaboration of randomized clinical trials to assess the efficacy of antihypertensive medication to slow the stenosis progression in patients with AS.

Keywords: Doppler echocardiography; aortic stenosis; calcific aortic valve disease; hypertension; multidetector computed tomography.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Figures

Figure 1

Progression of aortic valve calcification and coronary artery calcification according to the presence or absence of systolic hypertension. Comparison of the progression of AVC (A), and AVC indexed to the cross-sectional area of the aortic annulus (AVCdensity) (B) and CAC (n = 90) (C) according to the presence or absence of systolic hypertension (SHPT) at baseline [systolic blood pressure (SBP) ≥140 vs. <140 mmHg]. The box shows the 25th to 75th percentiles, the median line on the box shows the median value, and the error bars the 10th and 90th percentiles; circles are outliers; the numbers of the top of the graph are median [25th percentile–75th percentile]. Panel D shows representative MDCT images of aortic valve calcification at baseline and 2-year follow-up in two patients: Patient no.1 had a SBP of 143 mmHg at baseline, whereas Patient no. 2 had a SBP of 109 mmHg. AU, arbitrary unit(s); AVC, aortic valve calcification.

Figure 2

Progression of aortic valve calcification according to the presence or absence of systolic hypertension at baseline and at 2-year follow-up. Comparison of the progression of AVC (A) and AVCdensity (B) according to the presence or absence of SHPT at baseline and 2-year follow-up. The four boxes represent from left to right: patients with SHPT both at baseline and follow-up; patients with SHPT at baseline but not at follow-up; patients with SHPT at follow-up but not at baseline; and patients with no SHPT at baseline and follow-up. Abbreviations as in Table 1.