Echocardiographic aortic root dilatation in hypertensive patients: a systematic review and meta-analysis

Objective: The risk of thoracic aortic dissection is strictly related to the diameter of the ascending aorta. Arterial hypertension represents a major risk factor for the development of aortic dissection and is thought to be directly involved in the pathogenesis of aortic aneurysms. Recent studies have suggested a high prevalence of aortic root enlargement in the hypertensive population, but evidence of a direct link between blood pressure values and size of the aortic root has been inconclusive so far. The aim of the current study was to evaluate prevalence of aortic root dilatation (ARD) in the hypertensive population and to assess the correlates of this condition. Methods: Medical literature was reviewed to identify articles assessing prevalence of echocardiographic ARD in hypertensive patients. Results: A total of eight studies including 10 791 hypertensive patients were considered. Prevalence of ARD in the pooled population was 9.1% with a marked difference between men and women (12.7 vs. 4.5%; odds ratio 3.15; 95% confidence interval 2.68-3.71). Hypertensive patients with ARD and those with normal aortic root size had similar office blood pressure values, but the former were older and had a significantly higher left-ventricular mass (0.52 SDs, 95% confidence interval 0.41-0.63). Conclusion: ARD is a common phenotype in hypertensive patients, with men showing a markedly higher susceptibility, but office blood pressure values do not appear to be directly associated with aortic root diameter.