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Antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis

Jonathan Sen1,2, Erin Chung3, Christopher Neil1,2

  • 1Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.

BMJ Open
|October 6, 2020
PubMed

Insights

Antihypertensive therapy (AHT) in moderate or severe aortic stenosis (AS) is safe and well-tolerated. Renin-angiotensin-aldosterone system inhibitors (RAASi) specifically showed a reduced mortality risk in these patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Hypertension negatively impacts prognosis in moderate to severe aortic stenosis (AS).
  • Antihypertensive therapy (AHT) is underutilized in AS due to concerns about vasodilation and negative inotropic effects.

Purpose of the Study:

  • To evaluate the efficacy and safety of AHT in adult patients with moderate or severe AS.
  • To determine the impact of AHT on mortality and hemodynamic parameters in AS patients.

Main Methods:

  • Systematic review and meta-analysis of observational studies and randomized controlled trials.
  • Searched multiple databases including Cochrane, MEDLINE, and EMBASE up to September 2019.
  • Pooled effect sizes using random-effects models to assess outcomes like mortality and LV function.

Main Results:

  • AHT was not significantly associated with mortality across all pooled studies, though heterogeneity was substantial.
  • Renin-angiotensin-aldosterone system inhibitors (RAASi) demonstrated a significant reduction in mortality risk (HR 0.58).
  • No statistically significant differences were observed in hemodynamic or echocardiographic parameters with AHT compared to no AHT.

Conclusions:

  • Antihypertensive therapy (AHT) is generally safe and well-tolerated in patients with moderate or severe AS.
  • RAAS inhibitors offer a clinical benefit, associated with reduced mortality in this patient population.
  • Further research may clarify optimal AHT strategies for AS management.
Abstract

Keywords:
adult cardiologyhypertensionvalvular heart disease

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