What is the treatment for hypertension in patients with a bicuspid aortic valve (BAV)?

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From the Guidelines

The treatment for hypertension in patients with a bicuspid aortic valve (BAV) involves controlling blood pressure with any effective antihypertensive medication, with beta blockers and ARBs having conceptual advantages but lacking clinical evidence to support their use in reducing the rate of progression of aortic dilation. When managing hypertension in patients with BAV, the goal is to reduce the risk of cardiovascular events and prevent further complications. According to the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1, reducing cardiovascular events such as myocardial infarction and stroke, as well as preventing aneurysm growth and rupture, are the main goals in antihypertensive therapy. Some key points to consider when treating hypertension in patients with BAV include:

  • Achieving a systolic blood pressure (SBP) goal of <130 mm Hg and a diastolic blood pressure (DBP) goal of <80 mm Hg with the use of antihypertensive therapy can reduce adverse clinical outcomes 1
  • Beta blockers and agents that alter the renin angiotensin system have the most robust evidence of antihypertensive therapy in aortic disease, although no specific agent has been proven to inhibit aortic growth 1
  • The specific medication and dosage will depend on the patient's particular valve condition, blood pressure readings, and other health factors. Regular monitoring of blood pressure, heart function, and medication effectiveness is essential, as is following any activity restrictions recommended by the doctor. If the valve disease is severe, medication may only be supportive while surgical repair or replacement is considered as definitive treatment. The 2014 AHA/ACC guideline for the management of patients with valvular heart disease also supports the use of any effective antihypertensive medication to control blood pressure in patients with hypertension and BAV 1.

From the Research

Treatment for Hypertension in Patients with Bicuspid Aortic Valve (BAV)

  • The treatment for hypertension in patients with BAV is not well established, but several studies suggest the use of certain medications to manage the condition 2, 3, 4.
  • Beta-blockers are commonly used to decrease aortic wall stress and are considered first-line therapy for chronic type B aortic dissections 5.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have also been suggested for the medical therapy of type B TAD, but their effectiveness is not well established 3, 5.
  • Statins have been associated with decreased odds of ascending aortic dilatation in patients with BAV disease, but their role in preventing the progression of aortic dilatation is not well established 6.
  • The optimal blood pressure target in AS patients is not documented, and strict blood pressure control in the early postoperative phase in AS patients treated with transcatheter aortic valve replacement (TAVR) may be associated with adverse events 4.

Medications Used to Treat Hypertension in BAV Patients

  • Beta-blockers: used to decrease aortic wall stress and considered first-line therapy for chronic type B aortic dissections 5.
  • ACE inhibitors: suggested for the medical therapy of type B TAD, but their effectiveness is not well established 3, 5.
  • ARBs: suggested for the medical therapy of type B TAD, but their effectiveness is not well established 3, 5.
  • Statins: associated with decreased odds of ascending aortic dilatation in patients with BAV disease, but their role in preventing the progression of aortic dilatation is not well established 6.

Considerations for Managing Hypertension in BAV Patients

  • The presence of aortic stenosis, aortic regurgitation, and aortic root dilation should be considered when managing hypertension in BAV patients 3.
  • The use of medications such as beta-blockers, ACE inhibitors, and ARBs should be individualized based on the patient's specific condition and medical history 3, 5, 4.
  • Further research is needed to determine the optimal blood pressure target and treatment strategy for hypertension in BAV patients 4.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Managing complications of hypertension in aortic valve stenosis patients.

Expert review of cardiovascular therapy, 2018

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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