Assessing Optimal Blood Pressure in Patients with Asymptomatic Aortic Valve Stenosis: The SEAS Study

Background —Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis (AS) is scarce. We used data from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) trial to assess what blood pressure (BP) would be optimal. Methods —1767 patients with asymptomatic AS and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction (MI) and aortic valve replacement (AVR). Blood pressure was analyzed in Cox models as the cumulative average of serially measured BP as well as a time-varying covariate. Results —The incidence of all-cause mortality was highest for average follow up systolic BP ≥ 160 mmHg (4.3 per 100 person-year with 95% CI from 3.1 to 6.0) and lowest for average systolic BP 120-139 (2.0 per 100 person-year from 1.6 to 2.6). In multivariable analysis all-cause mortality was associated with average systolic BP < 120 mmHg (HR 3.4 with 95% CI from 1.9 to 6.1), diastolic BP ≥ 90 mmHg (HR 1.8 with 95% CI from 1.1 to 2.9) and pulse pressure < 50 mmHg (HR 1.8 with 95% CI from 1.1 to 2.9) taking systolic BP 120-139, diastolic BP 70-79 and pulse pressure 60-69 mmHg as reference. Low systolic and diastolic BP increased risk in patients with moderate AS. Using a time-varying systolic BP from 130 to 139 mmHg as reference, mortality was increased for systolic BP ≥ 160 mmHg (hazard ratio 1.7, p=0.033) and BP 120-129 mmHg (hazard ratio 1.6, p=0.039). Conclusions —Optimal BP seems to be systolic 130-139 mmHg and diastolic 70-90 mmHg in these patients with asymptomatic AS and no manifest atherosclerotic disease or diabetes. Clinical Trial Registration —http://www.clinicaltrials.gov; [NCT00092677][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00092677&atom=%2Fcirculationaha%2Fearly%2F2016%2F08%2F02%2FCIRCULATIONAHA.115.021213.atom