Hypertension in aortic stenosis: relationship with revealed symptoms and functional measures on treadmill exercise

The impact of hypertension on symptoms and functional capacity during exercise treadmill test (ETT) in apparently asymptomatic patients with aortic stenosis is poorly understood.

A total of 314 patients (age 65 ± 12 years, 68% men) with moderate or severe asymptomatic aortic stenosis underwent baseline echocardiography and ETT. Hypertension was defined as a history of elevated blood pressure (BP), past or current treatment with antihypertensive agents or a BP at the baseline clinic visit more than 140/90 mmHg.

There were 229 (73%) patients with hypertension who were older, more likely to have diabetes, hypercholesterolemia and coronary artery disease, larger left atrial diameters, higher left ventricular (LV) mass and a higher proportion of LV hypertrophy than normotensive patients. In a univariate logistic regression analysis hypertension and clinic SBP were not associated with revealed symptoms. In a multivariate logistic regression analysis, lower peak SBP [odds ratio (OR) 1.02;95% confidence interval (CI) 1.00-1.04, P = 0.017] and rapid early rise in heart rate (OR 15.03; 95% CI 6.23-36.24, P < 0.001) were associated with a higher risk of revealed symptoms while the use of antihypertensive treatment was associated with a lower risk of revealed symptoms (OR 0.40; 95% CI 0.18-0.89, P = 0.025), independent of age, obesity, LV ejection fraction and aortic valve area. In a linear regression analysis, after adjustment for age, sex and BMI, hypertension did not retain an association with lower metabolic equivalents (β = -0.06, P = 0.311).

Hypertension in aortic stenosis patients was associated with a high cardiovascular disease burden, but did not interact with symptoms or functional capacity during ETT. Hypertension does not interfere with the clinical interpretation of exercise testing.