BACKGROUND: Aortic valve sclerosis, a condition of thickening and calcification of the normal trileaflet aortic valve without the obstruction to left ventricular outflow, is associated with an increased incidence of cardiovascular events. Its prevalence increases with increasing age similar to the finding with hypertension. The objective was to critically review the data for a metanalysis on the association of blood pressure, hypertension and aortic valve sclerosis focusing on the possibility of a causal relationship.

METHODS: A systematic search of MEDLINE and EMBASE was conducted using the keywords hypertension and aortic valve. All English language papers were examined if they dealt with hypertension and aortic valve. All studies were included for analysis if they had a control group; regardless of definition of aortic valve sclerosis or hypertension.

FINDINGS: The data linking hypertension and aortic valve sclerosis are from a variety of studies which used markedly different definitions of hypertension and criteria for the definition of aortic valve sclerosis. Three population based cross sectional studies with a total sample size of 6450 individuals showed a consistent and significant relationship between hypertension and aortic valve sclerosis with an odds ratio ranging from 1.23 to 1.74. Three out of four case control studies with a total sample size of 1609 individuals also suggested a relationship between hypertension and aortic valve sclerosis with odds ratios ranging from 1.75 to 2.38. Only one small study (N=188) showed fewer cases with hypertension and aortic valve sclerosis than in the control group. Studies with blood pressure measurements consistently showed no increased blood pressures in the presence of aortic valve sclerosis. However, these studies did not examine the prevalence of aortic valve sclerosis within the different levels of blood pressure for individuals of the same age.

CONCLUSION: Critical evaluation of the literature suggests that there is compelling preliminary evidence to suggest a relationship between hypertension and aortic valve sclerosis. The weaknesses of this conclusion include the variety of definitions of hypertension and aortic valve sclerosis used by a number of the investigations and the absence of prospective data demonstrating a gradient of risk between increasing blood pressure and increasing incidence of aortic valve sclerosis. There are, however, several highly credible biological explanations to link hypertension and aortic valve sclerosis that require further investigation to establish the link between hypertension and aortic valve sclerosis so as to mitigate the adverse outcome of patients with aortic valve sclerosis.

DNC

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