High Blood Pressure Linked to Mitral Regurgitation

A new study establishes a strong link between high blood pressure and mitral regurgitation, the most common heart valve disorder in high-income countries.

Researcher at the University of Oxford (United Kingdom), the University of Sydney (Australia), and other institutions affiliated with the George Institute for Global Health (Sydney, Australia) used linked electronic health records (EHRs) from the UK Clinical Practice Research Datalink (CPRD) from January 1, 1990, to December 31, 2015, in order to test the hypothesis that elevated systolic blood pressure (SBP) across its usual spectrum is associated with higher risk of mitral regurgitation.

The results revealed that of the 5,553,984 patients registered in the CPRD that met inclusion criteria, 28,655 (0.52%) were diagnosed with mitral regurgitation during the 10-year follow-up period, and a further 1,262 (0.02%) were diagnosed with mitral stenosis. SBP was continuously related to the risk of mitral regurgitation, with no evidence of a nadir down to 115 mmHg. Each 20 mmHg increment in SBP was associated with a 26% higher risk of mitral regurgitation. No link was identified between SBP and mitral stenosis.

Associations were similar for each 10 mmHg increment in diastolic blood pressure (DBP), or each 15 mmHg increment in pulse pressure (PP). The association was partially mediated by diseases affecting the left ventricle that resulted in secondary mitral regurgitation, such as myocardial infarction (MI, ischemic heart disease, cardiomyopathy, and heart failure (HF). However, the excess risk mediated by these causes was only 13%, with little effect on long-term association between SBP and mitral regurgitation. The study was published on October 17, 2017, in PLOS Medicine.

“With worldwide aging and population growth, we are likely to see an increasing number of cases of this condition. We need to find effective and affordable measures to tackle it, and our study suggests one possible avenue for prevention, by reducing high blood pressure,” said lead author Professor Kazem Rahimi, MD, PhD, deputy director of The George Institute UK. “Given the large and growing burden of mitral valve disease, particularly among older people, we believe these findings are likely to have significant implications for medical policy and practice around the world.”

There is a well-established association between hypertension and increased risk for stroke, coronary heart disease, and renal failure.javascript:newshowcontent('active','references'); Another common cardiovascular condition is atrial fibrillation (AF), the most common sustained cardiac arrhythmia, which is associated with a high mortality and morbidity rate from stroke, thromboembolism, and HF. Studies have shown that the risk of stroke doubles in patients with AF who also suffer from hypertension.

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University of Oxford
University of Sydney
George Institute for Global Health