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

O. W. Nielsen; A. Sajadieh; M. Sabbah; Anders M Greve; M. H. Olsen; Karin Boman; Christoph A Nienaber; Y Antero Kesaniemi; T. R. Pedersen; Ronnie Willenheimer; K. 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)

O. W. Nielsen
, A. Sajadieh
, M. Sabbah
, Anders M Greve
, M. H. Olsen
, Karin Boman
, Christoph A Nienaber
, Y Antero Kesaniemi
, T. R. Pedersen
, Ronnie Willenheimer
, K. Wachtell

KI, OUH, Research unit of Endocrinology (Odense)

Research output: Contribution to journal › Journal article › Research › peer-review

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)	455-468
ISSN	0009-7322
DOIs	https://doi.org/10.1161/circulationaha.115.021213
Publication status	Published - 9. Aug 2016

Bibliographical note

ISI Document Delivery No.: DS6PN Times Cited: 1 Cited Reference Count: 18 Nielsen, Olav W. Sajadieh, Ahmad Sabbah, Muhammad Greve, Anders M. Olsen, Michael H. Boman, Kurt Nienaber, Christoph A. Kesaniemi, Y. Antero Pedersen, Terje R. Willenheimer, Ronnie Wachtell, Kristian Nielsen, Olav /S-4390-2016 Nielsen, Olav /0000-0003-3532-9431 Merck & Co, Inc, Whitehouse Station, NJ; Interreg IVA program, a part of the European Union The SEAS study was conducted with financial support from Merck & Co, Inc, Whitehouse Station, NJ. The sponsor provided the study authors with free access to all of the data; the authors were free to interpret the data and to write the article. The access to raw data, decision to publish, choice of analyses to include, and drafting of the manuscript were wholly controlled by the authors. This study was supported by a scientific grant from the Interreg IVA program, a part of the European Union. 1 8 10 Lippincott williams & wilkins Philadelphia 1524-4539

Keywords

aortic valve stenosis blood pressure hypertension mortality prognosis echocardiographic-assessment cardiovascular events hypertension guidelines management outcomes disease trial Cardiovascular System & Cardiology
blood pressure
aortic valve stenosis
mortality
hypertension
prognosis

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Nielsen, O. W., Sajadieh, A., Sabbah, M., Greve, A. M., Olsen, M. H., Boman, K., Nienaber, C. A., Kesaniemi, 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), 455-468. https://doi.org/10.1161/circulationaha.115.021213

@article{5d9cf0994bb641f9a029eaebec7135e1,

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 = "aortic valve stenosis blood pressure hypertension mortality prognosis echocardiographic-assessment cardiovascular events hypertension guidelines management outcomes disease trial Cardiovascular System \& Cardiology, blood pressure, aortic valve stenosis, mortality, hypertension, prognosis",

author = "Nielsen, \{O. W.\} and A. Sajadieh and M. Sabbah and Greve, \{Anders M\} and Olsen, \{M. H.\} and Karin Boman and Nienaber, \{Christoph A\} and Kesaniemi, \{Y Antero\} and Pedersen, \{T. R.\} and Ronnie Willenheimer and K. Wachtell",

note = "ISI Document Delivery No.: DS6PN Times Cited: 1 Cited Reference Count: 18 Nielsen, Olav W. Sajadieh, Ahmad Sabbah, Muhammad Greve, Anders M. Olsen, Michael H. Boman, Kurt Nienaber, Christoph A. Kesaniemi, Y. Antero Pedersen, Terje R. Willenheimer, Ronnie Wachtell, Kristian Nielsen, Olav /S-4390-2016 Nielsen, Olav /0000-0003-3532-9431 Merck \& Co, Inc, Whitehouse Station, NJ; Interreg IVA program, a part of the European Union The SEAS study was conducted with financial support from Merck \& Co, Inc, Whitehouse Station, NJ. The sponsor provided the study authors with free access to all of the data; the authors were free to interpret the data and to write the article. The access to raw data, decision to publish, choice of analyses to include, and drafting of the manuscript were wholly controlled by the authors. This study was supported by a scientific grant from the Interreg IVA program, a part of the European Union. 1 8 10 Lippincott williams \& wilkins Philadelphia 1524-4539",

year = "2016",

month = aug,

day = "9",

doi = "10.1161/circulationaha.115.021213",

language = "English",

volume = "134",

pages = "455--468",

journal = "Circulation",

issn = "0009-7322",

publisher = "American Heart Association",

number = "6",

}

Nielsen, OW, Sajadieh, A, Sabbah, M, Greve, AM, Olsen, MH, Boman, K, Nienaber, CA, Kesaniemi, 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. 455-468. https://doi.org/10.1161/circulationaha.115.021213

TY - JOUR

T1 - Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)

AU - Nielsen, O. W.

AU - Sajadieh, A.

AU - Sabbah, M.

AU - Greve, Anders M

AU - Olsen, M. H.

AU - Boman, Karin

AU - Nienaber, Christoph A

AU - Kesaniemi, Y Antero

AU - Pedersen, T. R.

AU - Willenheimer, Ronnie

AU - Wachtell, K.

N1 - ISI Document Delivery No.: DS6PN Times Cited: 1 Cited Reference Count: 18 Nielsen, Olav W. Sajadieh, Ahmad Sabbah, Muhammad Greve, Anders M. Olsen, Michael H. Boman, Kurt Nienaber, Christoph A. Kesaniemi, Y. Antero Pedersen, Terje R. Willenheimer, Ronnie Wachtell, Kristian Nielsen, Olav /S-4390-2016 Nielsen, Olav /0000-0003-3532-9431 Merck & Co, Inc, Whitehouse Station, NJ; Interreg IVA program, a part of the European Union The SEAS study was conducted with financial support from Merck & Co, Inc, Whitehouse Station, NJ. The sponsor provided the study authors with free access to all of the data; the authors were free to interpret the data and to write the article. The access to raw data, decision to publish, choice of analyses to include, and drafting of the manuscript were wholly controlled by the authors. This study was supported by a scientific grant from the Interreg IVA program, a part of the European Union. 1 8 10 Lippincott williams & wilkins Philadelphia 1524-4539

PY - 2016/8/9

Y1 - 2016/8/9

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 - aortic valve stenosis blood pressure hypertension mortality prognosis echocardiographic-assessment cardiovascular events hypertension guidelines management outcomes disease trial Cardiovascular System & Cardiology

KW - blood pressure

KW - aortic valve stenosis

KW - mortality

KW - hypertension

KW - prognosis

U2 - 10.1161/circulationaha.115.021213

DO - 10.1161/circulationaha.115.021213

M3 - Journal article

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

Bibliographical note

Keywords

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