Aortic root dilatation at sinuses of valsalva and aortic regurgitation in hypertensive and normotensive subjects - The Hypertension Genetic Epidemiology Network study

The association of sinuses of Valsalva dilatation and aortic regurgitation with hypertension is disputed, and few data are available in population-bas ed samples. We explored the relations of sinuses of Valsalva dilatation and aortic regurgitation to hypertension and additional clinical and echocardi ographic data in 2096 hypertensive and 361 normotensive participants in the Hypertension Genetic Epidemiology Network study. Age and body surface area were used to predict aortic root diameter using published equations develo ped from a separated reference population. Aortic dilatation was defined as measured sinuses of Valsalva diameter exceeding the 97.5th percentile of t he confidence interval of predicted diameter for age and body size. Aortic dilatation was present in 4.6% of the population After adjustment for age a nd body surface area, mean aortic root diameter was larger in hypertensives with suboptimal blood pressure control than normotensives or hypertensives with optimal blood pressure control. In multivariate models, sinuses of Va lsalva diameter was weakly positively related to diastolic blood pressure a nd to left ventricular mass independent of aortic regurgitation. Subjects w ith aortic dilatation were slightly older, were more frequently men, had hi gher left ventricular mass, and had lower left ventricular systolic chamber function independent of covariates. Sinuses of Valsalva dilatation was ind ependently related to male gender, aortic valve fibrocalcification, and ech ocardiographic wall motion abnormalities but not to diastolic blood pressur e (or history of hypertension in a separate model). The likelihood of aorti c regurgitation increased with larger aortic root diameter, older age, fema le gender, presence of aortic valve fibrocalcification, and lower body mass index but not hypertension or diabetes. In a subsequent model, diastolic b lood pressure was negatively related to aortic regurgitation independent of covariates. In a large population-based sample, sinuses of Valsalva diamet er was only mildly larger in subjects with suboptimally controlled hyperten sion than in normotensives or well-controlled hypertensives, which did not result in differences in prevalence of aortic regurgitation among groups, S inuses of Valsalva dilatation was associated with higher left ventricular m ass and lower systolic function, which may contribute to higher cardiovascu lar risk in subjects with aortic root dilatation.