Dear Editor,

I read with great interest the study by Little et al. (1) investigating the effect of acute blood pressure change on hemodynamic parameters of aortic stenosis (AS). Their implication that "differences in haemodynamics should be considered as a potential explanation for a change in AS severity independent of disease progression" should be stressed not only in clinical practice, but as well in prospective studies assessing the effect of medical treatment of AS. I would like to call attention to the coincidence of chronic blood pressure change in essential arterial hypertension with calcific AS, which may be much more frequent than previously reported. According to our data (2), hypertension was found in more than two thirds of 225 patients with nonrheumatic severe AS at the time of evaluation for surgery. Such a high percentage, however, should not be a surprise, as it is similar to the prevalence in the general population of corresponding age and gender (3). Within last decade, vasodilators have become common part of antihypertensive medication in clinical practice (2, 4), though their good tolerance in patients with AS has been demonstrated prospectively only recently (5). To conclude, in patients with AS arterial hypertension is frequent, should be actively sought after, and carefully controlled.

References

1. Little SH, Chan KL, Burwash IG.
Impact of blood pressure on the Doppler echocardiographic assessment of severity of aortic stenosis.
Heart 2007;93:848-855.

2. Linhartová K, Filipovský J, Èerbák R, et al.
Severe aortic stenosis and its association with hypertension: analysis of clinical and echocardiographic parameters.
Blood Pressure 2007;16:122-128.

3. Hajjar I, Kotchen A.
Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000.
JAMA 2003;290:199-206.

4. Rosenhek R, Rader F, Loho N, et al.
Statins but not angiotensin- converting enzyme inhibitors delay progression of aortic stenosis.
Circulation, 2004;110:1291-1295.

5. Jimenez-Candil J, Bermejo J, Yotti R, et al.
Effects of angiotensin converting enzyme inhibitors in hypertensive patients in aortic stenosis: a drug withdrawal study.
Heart 2005;91:1311-8.