Key result
ACE inhibitors and ARBs appear safe and beneficial in patients with aortic stenosis, improving survival and left ventricular remodeling without causing significant hypotension or syncope.
Why the study?
ACEIs and ARBs are widely considered contraindicated in aortic stenosis due to hypotension and syncope risks, despite potential cardioprotective benefits and positive effects on left ventricular remodelling.
Do ACE inhibitors improve survival and cardiac function safely in patients with aortic stenosis?
Do ACE inhibitors improve survival and cardiac function safely in patients with aortic stenosis?
ACE inhibitors appear safe and potentially beneficial in patients with aortic stenosis, challenging the historical belief that they are contraindicated due to vasodilatory effects.
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-2 receptor blockers (ARBs) are used extensively in the treatment of arterial hypertension. There is a widespread belief that these drugs are contraindicated in patients with underlying aortic stenosis due to their vasodilatory effect, which could result in hypotension and syncope. Nonetheless, these drugs may significantly benefit such patients with their proven cardioprotective benefits and positive effects on left ventricular remodelling. Despite widespread concerns about their safety, the currently available studies do not report any significant side effects. Оn the contrary, they find improved survival rates, a reduction in adverse cardiovascular events, and a reduction in symptoms. Further clinical studies and trials are necessary to assess the safety of ACEIs in patients with hypertension and underlying aortic stenosis and their effects on cardiac function and survival.
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Yambolov et al. (2022) conducted a review in Aortic stenosis. ACE inhibitors and ARBs was evaluated. ACE inhibitors and ARBs appear safe and beneficial in patients with aortic stenosis, improving survival and left ventricular remodeling without causing significant hypotension or syncope.
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