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

Background : Systolic hypertension is one of the most frequent comorbidities encountered in patients with aortic stenosis (AS). In a recent study, we reported that systolic hypertension is associated with faster hemodynamic progression of AS and reduced survival. However, the impact of hypertension on the progression of aortic valve calcification (AVC), which is the culprit lesion of AS, is unknown. The main objective of this prospective study was to assess the impact of systolic hypertension on the progression of AVC in AS patients. Methods : One hundred and one patients with AS were prospectively recruited in the PROGRESSA study (NCT01679431). AVC and coronary artery calcification (CAC) were measured by multidetector computed tomography at baseline and at 2-year follow-up using the Agatston method. Results : The mean age was 65 ±13 years and 74% were male. During the 2-year follow-up, patients with systolic hypertension (i.e. systolic blood pressure =140 mmHg; n=37) at baseline had faster progression of AVC compared to those with no systolic hypertension (AVC: +370 [126-824] vs. +157 [58-303] vs. +157 [58-303 AU; p=0.007; Figure). In multivariable analysis adjusted for age, sex, antihypertensive treatment, dyslipidemia, diabetes, metabolic syndrome, creatinine level, baseline hemodynamic AS severity, and baseline AVC, systolic hypertension remained an independent predictor of faster progression of AVC (p=0.001). In contrast, there was no significant difference in the progression of CAC between patients with versus without systolic hypertension (CAC: +39 [3-199] vs. +116 [28-189] AU; p=0.17; Figure). Conclusion : This prospective study shows that systolic hypertension is a powerful and independent predictor of faster progression of AVC but not of CAC in patients with AS. These findings emphasize the difference in the pathological processes leading to valvular versus vascular mineralization, and provide further to support the elaboration of randomized clinical trials targeting the treatment of hypertension in patients with A