Abstract 2522: Angiotensin Converting Enzyme Inhibitor is the Only Drug that Slows the Progression of Aortic Stenosis among First-line Antihypertensive Agents
Background: E pidemiological studies suggested that hypertension is one of the risk factors of non-rheumatic aortic stenosis (AS). However, the effect of antihypertensive agents on the progression of AS is unclear. Statin is only a drug whose effect on the progression of AS was examined in randomized controlled trials, but there are conflicting results.
Objectives: To examine the effect of first-line antihypertensive agents such as angiotensin converting enzyme inhibitor (ACEI), angiotensin II type 1 receptor blocker (ARB), diuretics, beta-blocker, and calcium channel blocker (CCB) on the progression of AS. We also examined whether statin use affected the progression of AS.
Methods: We studied 293 consecutive patients (from Feb 2005 to Mar 2007, aged 71±10 years, 153 females) with native valves with peak aortic flow velocity (AFV) ≥2.0 m/sec in whom 2 or more echocardiograms were done with an interval of at least 6 months in echo lab of Hyogo Collage of Medicine and Osaka University Hospital. We reviewed antihypertensive agents and statin that had been administrated more than 6 months during the follow up period. The data were retrospectively reviewed to determine yearly changes of AFV (ΔV) and the trans-aortic pressure gradient (ΔPG, determined by using a simplified Bernoulli equation). Progression rate was compared between users and non-users for each of the medications. To eliminate the inter-relations among antihypertensive agents and statin, stepwise regression analysis was added.
Results: ΔV/yr and ΔPG/yr in each of the agents are shown in the table⇓. Stepwise regression analysis revealed that ACEI is an only medication that affects ΔV/yr and ΔPG/yr. Such protective associations were not observed for ARBs, beta blockers, CCBs, diuretics, and statins.
Conclusions: ACEI is the only drug that slows the progression of AS among first-line antihypertensive agents.