Abstract 13242: What is the Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The SEAS Study
Introduction: Very limited data regarding blood pressure and antihypertensive treatment in asymptomatic aortic valve stenosis (AS) have been published, and no announced consensus statement has provided recommendations for optimal blood pressure targets in this patient population.
Hypothesis: Our research question was to use the best available observational data from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) trial to identify what blood pressure (BP) would be optimal in terms of mortality in asymptomatic AS.
Methods: We evaluated 1798 patients with asymptomatic AS enrolled in the SEAS trial. Average follow-up BP was examined. Primary outcome was all-cause mortality, and secondary outcomes were cardiovascular death, heart failure, stroke and aortic valve replacement (AVR).
Results: Average blood pressure was 144/82 mmHg and half the patients had a history of hypertension. In multivariate analysis, all-cause mortality was increased for systolic BP < 120 (HR=5, p<0.001), systolic 120-139 (HR=1.5, p=0.031) and diastolic BP >= 90 mmHg (HR=1.9, p=0.015). Adjusting for time dependent in-between events such as aortic valve replacement, heart failure and non-fatal myocardial infarction did not significantly modify the risk. Patients at 75 years of age or more with history of hypertension had increased mortality risk with diastolic BP >= 90 mmHg (HR= 3.3, p=0.004). Patients below 75 years of age with a history of hypertension had an increased risk with systolic BP >= 160 mmHg (HR=2.1, p=0.049).
Conclusions: In asymptomatic aortic valve stenosis all-cause mortality is lowest at a systolic BP between 140 to 159 mmHg and at a diastolic between 70 to 89 mmHg. Patients with low systolic blood pressure, in general, had increased mortality risk, and should undertake individual clinical assessment.
Author Disclosures: O.W. Nielsen: None. A. Sajadieh: None. M. Sabbah: None. A.M. Greve: None. M.H. Olsen: None. K. Boman: None. C.A. Nienaber: None. A. Kesäniemi: None. T. Pedersen: None. R. Willenheimer: None. K. Wachtell: None.
- © 2015 by American Heart Association, Inc.