Increasing Prevalence of Hypertension Among Patients With Thoracic Aorta Dissection: Trends Over Eight Decades—A Structured Meta-analysis

BACKGROUND: This structured metaanalysis focused on determining the relationship between hypertension (HTN) and thoracic aortic dissection (TAD). METHODS: Electronic searches were conducted using the MedLine database, for the period 1946 through May 2013, and manual searches from reference lists. Demographic data, patient diagnosis, and HTN prevalence were extracted from each study. Data were analyzed using weighted averages, metaanalysis, analysis of variance, trend analysis, and multivariate analysis. RESULTS: A total of 8,086 cases of TAD from 75 studies over eight decades were assessed. Overall prevalence of HTN in TAD was 66.7% ± 17.5%. An increase of approximately 5.6% in HTN prevalence in TAD cases occurred in every decade. Prevalence of HTN in type A dissections steadily increased, with an overall prevalence of 64.8% ± 21.3%, while in type B dissections, prevalence abruptly increased from 1950 to 1970 and remained constant thereafter, with an overall prevalence of 78.7% ± 8.6%. Trend analysis demonstrated significant (P < 0.001) and linear increasing trends for the prevalence of HTN and age at presentation. Multivariate analysis demonstrated that a history of HTN was significantly (P < 0.001) associated with increasing trends of over time, which was independent of the relationship between age and TAD. CONCLUSIONS: The proportion of TAD patients with HTN has been increasing over eight decades. Age at presentation of TAD has also been incrementally increasing, but the increase in HTN was independent of age in multivariate analysis. The trend for increasing HTN prevalence was more evident in type A TAD. These data highlight a need to focus on HTN management in patients with thoracic aortic aneurysm.