In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Introduction: Hypertension (HTN) is common for patients with AS. However, whether it is a sign of a healthy ventricle and therefore a good prognostic sign, or a risk factor remains unclear. We sought to evaluate the effect of HTN on survival in AS patients at a large referral center. Methods: Echocardiograms conducted at Tufts Medical Center (Boston, MA) were screened and parameters were extracted from a central database. NLP was used on unstructured clinical visit notes to fill in missing data. AS severity was defined as [mild (Vmax: 2.5- 2.9 m/s, MG: 10-20 mmHg, AVA: 〉 1.5 cm2), moderate (Vmax: 3.0-3.9, MG: 20-40, AVA: 1.0-1.5) or severe (Vmax: 〉 4.0, MG: 〉 40, AVA: 〈 1.0)]. Cox proportional hazard regression models assessed the association between hypertension stage [Normotensive: SBP 〈 120 mmHg, Elevated: SBP 120-129 mmHg, Stage 1: 130-139 mmHg, Stage 2: 〉 140 mmHg] taken at the time of the echocardiographic exam and death. Models were adjusted for age, sex, ejection fraction, BMI, and degree of mitral regurgitation. The last echocardiographic time point prior to death or being censored alive was used for modeling. Results: Of the 160,491 echocardiographic exams performed between 2006-2021 2,699 had mild AS or greater. Patients were followed for a median of 533 days for mild (N = 319), 593 days for moderate (N = 1070), and 76 days for severe (N = 1310). Overall mortality was lowest for moderate and severe AS (log-rank test: P 〈 0.001). HTN was associated with decreased mortality relative to a normotensive state at moderate (HR: Elevated 0.67 CI: 0.35-1.26, Stage 1 0.35 CI: 0.19-0.63, Stage 2 0.52 CI: 0.31-0.87) and severe stenosis (HR: Elevated 0.64 CI: 0.25-1.59, Stage 1 0.29 CI: 0.12-0.66, Stage 2 0.42 CI: 0.22-0.81). Conclusions: Contrary to other cardiovascular diseases HTN was associated with decreased mortality for this large cohort with significant AS. This observation raises questions about whether traditional HTN treatment targets are appropriate for patients with AS.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.10270
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
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