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Systolic Hypertension and Discrepancies in the Progression of Calcific Valve Stenosis - Results from the PROGRESSA Study -

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Background: Systolic hypertension (SHPT, i.e. systolic blood pressure ≥140 mmHg) is one of the most frequent comorbidities encountered in patients with aortic stenosis (AS).

Objective: This prospective study sought to examine the impact of SHPT both on the progression of aortic valve calcification (AVC) and hemodynamic progression of AS.

Methods: One hundred and one patients with AS were prospectively recruited in the PROGRESSA study. AVC progression was measured by multidetector computed tomography using the Agatston method and hemodynamic progression was assessed by increase in peak aortic jet velocity (Vpeak) measured by Doppler Echocardiography, both at baseline and at 2-year follow-up.

Results: The mean age was 65±13 years and 74% were male. During the 2-year follow-up, patients with SHPT (n=37) at baseline had faster progression of AVC compared to those without SHPT (AVC: +370[126-824] vs. +157[58-303] AU; p=0.007, Figure Panel A). In contrast, there was no significant difference in hemodynamic progression between two groups (Vpeak: +21[8-34] vs. +18[2-40] cm/s; p=0.80, Figure Panel B). In multivariable analysis adjusted for age, sex, dyslipidemia, diabetes, metabolic syndrome, antihypertensive medication, creatinine level, baseline Vpeak and baseline AVC, SHPT remained significantly associated with faster progression of AVC (p=0.001). Interestingly, there was a significant interaction between SHPT and AVC progression on hemodynamic AS progression (pinteraction<0.0001). In patients with SHPT, AVC progression was not associated with Vpeak progression (p=0.35), whereas in those without SHPT, there was a significant association (p<0.0001).

Conclusion: This prospective study shows that SHPT is a powerful and independent predictor of faster progression of AVC but not of hemodynamic progression in AS patients. These findings suggest that hemodynamic progression of AS may be underestimated in presence of SHPT. Future clinical trials are needed to assess the efficacy of antihypertensive treatment on the progression of valve stenosis.

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