Key result
SGLT2 inhibitors and beta-blockers link to improved hemodynamics in low-flow, low-gradient severe AS.
Why the study?
While GDMT for hypertension is recommended for early progressive AS, there are no guideline-recommended antihypertensive therapies for stage D low-flow, low-gradient severe AS.
Do specific antihypertensive medication classes alter the progression of echocardiographic hemodynamic severity parameters in patients with classical and paradoxical low-flow, low-gradient severe aortic stenosis?
Cohort (n=218)
No
Do specific antihypertensive medication classes alter the progression of echocardiographic hemodynamic severity parameters in patients with classical and paradoxical low-flow, low-gradient severe aortic stenosis?
In patients with low-flow, low-gradient severe aortic stenosis, SGLT2 inhibitors and beta-blockers were associated with favorable reductions in echocardiographic severity parameters, whereas ACE inhibitors and ARBs were not.
Answers are grounded in this paper and cite their sources.
Should not yet alter antihypertensive choices in low-flow low-gradient AS; leaves open hypothesis-generating associations needing randomized confirmation.
Background: While the left ventricular (LV) hypertrophy and diffuse interstitial fibrosis characteristic of the pathophysiology of aortic stenosis (AS) are reversed by aortic valve replacement (AVR), the definitive treatment for AS, angiotensin modulators have demonstrated antifibrotic effects in animal models of AS. While goal-directed medical therapy (GDMT) treatment of hypertension is recommended for the early progressive stages of AS, there are no guideline-recommended antihypertensive therapies for stage D low-flow, low-gradient (LFLG) severe AS. Methods: All echocardiographic studies performed at South Shore University Hospital between January 2020 and December 2024 were retrospectively reviewed to identify a cohort of patients with LFLG severe AS. The progression of echocardiographic hemodynamic severity parameters was then examined according to prescribed antihypertensive medications in this cohort of 218 patients followed for a mean period of 19.1 months. Results: In this cohort, the prevalence of LFLG severe AS with preserved left ventricular ejection fraction (LVEF) was 72.9%. Angiotensin-converting enzyme (ACE) inhibitors were not associated with any statistically significant change in hemodynamic severity markers, whereas angiotensin receptor blockers (ARBs) were associated with a statistically significant increase in peak jet velocity in a subset of the cohort (p = 0.042). Conclusion: In this cohort, angiotensin modulators were not associated with slower progression of AS severity parameters. Rather, the GDMT members - sodium-glucose cotransporter 2 (SGLT2) inhibitors and beta-blockers - were associated with differential reductions in stenosis severity markers in patients with LFLG severe AS.
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Grant et al. (2026) conducted a cohort in Low-flow, low-gradient severe aortic stenosis (n=218). Antihypertensive medications (including SGLT2 inhibitors, beta-blockers, ACE inhibitors, and ARBs) vs. No use of the respective medication class was evaluated on Change in peak jet velocity in classical LFLG AS associated with ARB use (Coefficient 1.972, p=0.042). In patients with low-flow, low-gradient severe aortic stenosis, SGLT2 inhibitors and beta-blockers were associated with reductions in stenosis severity markers, whereas ARBs were associated with an increase in peak jet velocity.
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