Research reveals link between high blood pressure and risk of aortic valve disease

New research has found that long-term exposure to high blood pressure is associated with an increased risk of aortic valve disease, with significant implications for clinical practice guidelines and health management.

“Aortic valve disease typically emerges in later adulthood, and in the absence of any known tools for its prevention, we have been thinking of it as a disease of old age that we can do little about,” said research lead and Deputy Director of The George Institute UK, Professor Kazem Rahimi.

“Clinical practice guidelines currently make little reference to preventative strategies, but this study suggests high blood pressure should be considered a major risk factor for aortic valve disease, much as it is for heart attacks, stroke and other cardiovascular diseases.”

The findings, published in the European Heart Journal today, are from a study of 5.4 million adults in the UK, led by The George Institute for Global Health at the University of Oxford.

They reveal that each 20 mmHg increase in systolic blood pressure is linked to a 41% greater risk of developing aortic stenosis, a condition in which the valve that controls how blood is pumped from the heart to the main artery doesn’t open fully. People with a systolic blood pressure of 161 mmHg or more were twice as likely to be diagnosed with the condition as those with a systolic blood pressure of 120 mmHg or lower.

Higher blood pressure is also linked to a greater risk of aortic regurgitation, when the aortic valve doesn’t close properly and blood leaks back into the heart. Each 20 mmHg increase in systolic blood pressure is linked to a 38% greater risk of developing this condition.

Patients with aortic valve disease may suffer symptoms such as chest pain, shortness of breath, fatigue, fainting and dizziness. The new research provides further evidence of the importance of controlling hypertension, and has significant implications for health guidelines and clinical practice.

Dr Stefano Masi from the Department of Clinical and Experimental Medicine at the Università di Pisa, Italy, and Dr Alberto Giannoni from the Fondazione Toscana Gabriele Monasterio, Pisa, commented in an editorial that the study “provides the first solid evidence supporting the need for a radical shift in the approach to aortic valve disease (AVD), [...and] might stimulate new lines of research, particularly imaging studies, with the scope of identifying early alterations of the aortic valve in patients with hypertension that might be highly predictive of future AVD.”

While the study suggests that the association between higher blood pressure and a greater risk of aortic valve disease is causal, further investigation is needed to explore why this may be the case; in particular, whether raised blood pressure may be an indication of an underlying problem with stiffness in the aortic valve that is caused by something else.

The study was funded by the National Institute for Health Research through the Oxford Biomedical Research Centre, and by the Oxford Martin School at the University of Oxford.