Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)

Olav W Nielsen; Ahmad Sajadieh; Muhammad Sabbah; Anders M Greve; Michael H Olsen; Kurt Boman; Christoph A Nienaber; Y Antero Kesäniemi; Terje R Pedersen; Ronnie Willenheimer; Kristian Wachtell

doi:10.1161/CIRCULATIONAHA.115.021213

Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)

Olav W Nielsen, Ahmad Sajadieh, Muhammad Sabbah, Anders M Greve, Michael H Olsen, Kurt Boman, Christoph A Nienaber, Y Antero Kesäniemi, Terje R Pedersen, Ronnie Willenheimer, Kristian Wachtell

Department of Clinical Medicine

24 Citations (Scopus)

Abstract

BACKGROUND: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal.

METHODS: A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate.

RESULTS: The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95% confidence interval [CI], 3.1-6.0) and lowest for average systolic BP of 120 to 139 mm Hg (2.0 per 100 person-years; 95% CI, 1.6-2.6). In multivariable analysis, all-cause mortality was associated with average systolic BP <120 mm Hg (hazard ratio [HR], 3.4; 95% CI, 1.9-6.1), diastolic BP ≥90 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), and pulse pressure <50 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), with systolic BP of 120 to 139 mm Hg, diastolic BP of 70 to 79 mm Hg, and pulse pressure of 60 to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0.039).

CONCLUSIONS: Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.

Original language	English
Journal	Circulation
Volume	134
Issue number	6
Pages (from-to)	455-68
Number of pages	14
ISSN	0009-7322
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.115.021213
Publication status	Published - 2016

Keywords

Aged
Anticholesteremic Agents
Aortic Valve Stenosis
Blood Pressure
Double-Blind Method
Ezetimibe
Follow-Up Studies
Humans
Hypertension
Middle Aged
Simvastatin
Journal Article
Multicenter Study
Observational Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/CIRCULATIONAHA.115.021213

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Nielsen, O. W., Sajadieh, A., Sabbah, M., Greve, A. M., Olsen, M. H., Boman, K., Nienaber, C. A., Kesäniemi, Y. A., Pedersen, T. R., Willenheimer, R., & Wachtell, K. (2016). Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS). Circulation, 134(6), 455-68. https://doi.org/10.1161/CIRCULATIONAHA.115.021213

Nielsen, OW , Sajadieh, A, Sabbah, M, Greve, AM, Olsen, MH, Boman, K, Nienaber, CA, Kesäniemi, YA, Pedersen, TR, Willenheimer, R & Wachtell, K 2016, 'Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)', Circulation, vol. 134, no. 6, pp. 455-68. https://doi.org/10.1161/CIRCULATIONAHA.115.021213

@article{09b9482379614deebb6bbe6c0cb4deef,

title = "Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)",

abstract = "BACKGROUND: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal.METHODS: A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate.RESULTS: The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95% confidence interval [CI], 3.1-6.0) and lowest for average systolic BP of 120 to 139 mm Hg (2.0 per 100 person-years; 95% CI, 1.6-2.6). In multivariable analysis, all-cause mortality was associated with average systolic BP <120 mm Hg (hazard ratio [HR], 3.4; 95% CI, 1.9-6.1), diastolic BP ≥90 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), and pulse pressure <50 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), with systolic BP of 120 to 139 mm Hg, diastolic BP of 70 to 79 mm Hg, and pulse pressure of 60 to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0.039).CONCLUSIONS: Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.",

keywords = "Aged, Anticholesteremic Agents, Aortic Valve Stenosis, Blood Pressure, Double-Blind Method, Ezetimibe, Follow-Up Studies, Humans, Hypertension, Middle Aged, Simvastatin, Journal Article, Multicenter Study, Observational Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't",

author = "Nielsen, {Olav W} and Ahmad Sajadieh and Muhammad Sabbah and Greve, {Anders M} and Olsen, {Michael H} and Kurt Boman and Nienaber, {Christoph A} and Kes{\"a}niemi, {Y Antero} and Pedersen, {Terje R} and Ronnie Willenheimer and Kristian Wachtell",

note = "{\textcopyright} 2016 American Heart Association, Inc.",

year = "2016",

doi = "10.1161/CIRCULATIONAHA.115.021213",

language = "English",

volume = "134",

pages = "455--68",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

number = "6",

}

TY - JOUR

T1 - Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis

T2 - The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)

AU - Nielsen, Olav W

AU - Sajadieh, Ahmad

AU - Sabbah, Muhammad

AU - Greve, Anders M

AU - Olsen, Michael H

AU - Boman, Kurt

AU - Nienaber, Christoph A

AU - Kesäniemi, Y Antero

AU - Pedersen, Terje R

AU - Willenheimer, Ronnie

AU - Wachtell, Kristian

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal.METHODS: A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate.RESULTS: The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95% confidence interval [CI], 3.1-6.0) and lowest for average systolic BP of 120 to 139 mm Hg (2.0 per 100 person-years; 95% CI, 1.6-2.6). In multivariable analysis, all-cause mortality was associated with average systolic BP <120 mm Hg (hazard ratio [HR], 3.4; 95% CI, 1.9-6.1), diastolic BP ≥90 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), and pulse pressure <50 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), with systolic BP of 120 to 139 mm Hg, diastolic BP of 70 to 79 mm Hg, and pulse pressure of 60 to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0.039).CONCLUSIONS: Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.

AB - BACKGROUND: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal.METHODS: A total of 1767 patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate.RESULTS: The incidence of all-cause mortality was highest for average follow-up systolic BP ≥160 mm Hg (4.3 per 100 person-years; 95% confidence interval [CI], 3.1-6.0) and lowest for average systolic BP of 120 to 139 mm Hg (2.0 per 100 person-years; 95% CI, 1.6-2.6). In multivariable analysis, all-cause mortality was associated with average systolic BP <120 mm Hg (hazard ratio [HR], 3.4; 95% CI, 1.9-6.1), diastolic BP ≥90 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), and pulse pressure <50 mm Hg (HR, 1.8; 95% CI, 1.1-2.9), with systolic BP of 120 to 139 mm Hg, diastolic BP of 70 to 79 mm Hg, and pulse pressure of 60 to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0.039).CONCLUSIONS: Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.

KW - Aged

KW - Anticholesteremic Agents

KW - Aortic Valve Stenosis

KW - Blood Pressure

KW - Double-Blind Method

KW - Ezetimibe

KW - Follow-Up Studies

KW - Humans

KW - Hypertension

KW - Middle Aged

KW - Simvastatin

KW - Journal Article

KW - Multicenter Study

KW - Observational Study

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1161/CIRCULATIONAHA.115.021213

DO - 10.1161/CIRCULATIONAHA.115.021213

M3 - Journal article

C2 - 27486164

SN - 0009-7322

VL - 134

SP - 455

EP - 468

JO - Circulation

JF - Circulation

IS - 6

ER -

Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)

Abstract

Keywords

UN SDGs

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