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Newly Diagnosed Aortic Sclerosis is associated with Uncontrolled Hypertension: A Nested Case Control Study From The Oxvalve Population Cohort Study
Margaret Loudon,
Sean Coffey, Joanna d'Arcy, Andrew Kennedy, Bernard Prendergast.
Oxford University Hospitals NHS Trust, Oxford, United Kingdom.

OBJECTIVE:Aortic valve sclerosis (AVS) is associated with a 50% excess risk of cardiovascular events and affects around 30% of those over 65 years of age. We examine the relationship between aortic sclerosis and hypertension in 600 patients with AVS identified within the larger OXVALVE population cohort study (OxVALVE-PCS).
METHODS:OxVALVE-PCS is a large ongoing, community based study in Oxfordshire, UK identifying newly diagnosed valvular heart disease (VHD) in subjects aged greater than 65 years. We compared the incidence and treatment of hypertension in the first 600 subjects with a new diagnosis of AVS identified on transthoracic echocardiography with nested controls within the larger OxVALVE population.
RESULTS: Systolic blood pressure was higher in those with a new diagnosis of AVS when compared with age matched controls without significant valvular heart disease (143.5mmHg vs 140.1mmHg, p=0.003) despite a similar proportion of previous diagnoses of hypertension (50.0% vs 47.6%, p=0.41). Importantly, when a cohort with known hypertension and AVS was compared to controls with known hypertension but no AVS, a persistent increase in systolic blood pressure remained (145.9±20.5mmHg versus 141.9±18.8 mmHg; p=0.01), despite similar levels of antihypertensive treatment.
CONCLUSIONS: Aortic sclerosis is associated with more severe systolic hypertension when compared with age matched controls. This difference persists amongst those with known hypertension on treatment, suggesting therapeutic resistance. Mechanisms underlying this association and its pathophysiological explanation warrant further exploration followed by randomised controlled trials to investigate potential treatments to reduce the risks associated with this common condition.

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