e4 Article TypeCo respondence To the Editor:

I read with great interest the recent study by Eleid et al1 on the topic of systemic arterial hypertension in patients with low-gradient severe aortic stenosis and preserved ejection fraction. The concept that alterations in systemic arterial hemodynamics may have unique and unexpected consequences for patients with aortic valve stenosis is particularly important given the current emphasis on the recogni-tion and treatment of aortic valve stenosis. Eleid et al have nicely shown that afterload reduction with nitro-prusside in patients with aortic valve stenosis, low gradients (at rest), and severe systemic arterial hypertension not only results in the reduction in intracardiac filling pressures (in patients with sys-temic arterial vasoconstriction), but also alters aortic valve hemo-dynamics in a remarkable manner—transvalvular flow increases (to a variable degree) as does calculated aortic valve area (to a variable degree). Such behavior is understandable if the totality o