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Causal effect of hypertension and blood pressure on aortic diseases: evidence from Mendelian randomization

Tao Yang1, Xin Yuan1, Wei Gao1

  • 1Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|July 13, 2023
PubMed

Insights

Hypertension and high diastolic blood pressure (DBP) causally increase the risk of aortic aneurysm and dissection. These findings highlight the importance of managing hypertension, particularly DBP, for preventing aortic diseases.

Area of Science:

  • Cardiovascular Genetics
  • Aortic Disease Research
  • Epidemiology

Background:

  • Observational studies suggest hypertension is a risk factor for aortic diseases, but causality is unconfirmed.
  • Aortic aneurysm and dissection are serious conditions with significant morbidity and mortality.
  • Understanding the causal link between blood pressure and aortic diseases is crucial for effective prevention.

Purpose of the Study:

  • To investigate the causal relationship between hypertension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) with aortic aneurysm and aortic dissection.
  • To utilize a robust Mendelian randomization approach to establish causality.
  • To inform preventive strategies for aortic diseases.

Main Methods:

  • Employed a two-sample Mendelian randomization (MR) approach using genetic instruments from large genome-wide association studies.
  • Analyzed summary statistics for hypertension, SBP, DBP, aortic aneurysm, and aortic dissection.
  • Utilized inverse variance weighted (IVW) method and performed sensitivity analyses (MR-Egger, weighted median, multivariable MR).

Main Results:

  • Genetic liability to hypertension was causally associated with increased risk of aortic dissection (OR: 1.81) and aortic aneurysm (OR: 1.43).
  • Each standard deviation increase in genetically determined DBP significantly elevated the risk of aortic dissection (OR: 1.14) and aortic aneurysm (OR: 1.07).
  • No significant causal association was found between genetically determined SBP and aortic dissection or aneurysm.

Conclusions:

  • Hypertension and elevated DBP are causally linked to increased risks of aortic aneurysm and aortic dissection.
  • Preventive interventions for aortic diseases should consider individuals with hypertension, especially those with high DBP.
  • Further research is needed to elucidate the mechanisms behind the stronger correlation of DBP than SBP with aortic diseases.

Keywords:
Aortic aneurysmAortic dissectionDiastolic blood pressureHypertensionSystolic blood pressure

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