Managing complications of hypertension in aortic valve stenosis patients

Hypertension is highly prevalent in aortic valve stenosis (AS) patients as the prevalence of both disorders increases with age. Hypertension and associated stiffening of the large arteries increase afterload and thereby influence both the transvalvular flow and the remodeling of the aortic root and the left ventricle during AS progression. Area covered: The present review gives an overview on complications of hypertension in AS, how these can be diagnosed, and potentially may be managed. Expert commentary: Hypertension-mediated cardiovascular (CV) damage in AS is associated with increased morbidity and a twofold higher mortality even in asymptomatic patients, and also limits the symptomatic and survival benefit from valve replacement. Data from registries and post hoc analyses from outcome studies in AS suggest that treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers, respectively, is safe and associated with improved survival and reduced CV events in these patients. However, optimal blood pressure (BP) target in AS patients is not documented, and strict BP control in the early postoperative phase in AS patients treated with transcatheter aortic valve replacement (TAVR) may be associated with adverse events. Thus, randomized studies on BP management in asymptomatic AS and post-TAVR patients are highly needed.