Abstract 13786: Angiotensin-Receptors Blockers are Associated with Reduced Progression of Aortic Stenosis
BACKGROUND: Recent experimental studies suggested that activation of renin-angiotensin system (RAS) could play a role in calcific aortic stenosis (AS), but previous clinical studies have provided conflicting results. Our aim was to examine the effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) on AS progression.
METHODS: 340 consecutive patients with AS and preserved LV ejection fraction were included; 16% were on ARBs and 34% on ACEIs, 50% had no RAS medication (23% with hypertension (HTN group) and 27% without HTN (Ctrl group)).AS progression rate was evaluated by annualized peak aortic jet velocity (Vpeak).
RESULTS: Patients with RAS inhibitors were older (p=0.0009) and had higher prevalence of coronary artery disease (CAD) (p<0.0001), hyperlipidemia (p<0.0001) and diabetes (p<0.0001). Baseline AS severity was similar in all 4 groups (mean Vpeak: 2.9±0.5 m/s). When compared to Ctrl group, HTN group had faster (p=0.006) AS progression (Figure). ARBs group tended (p=0.1) to have slower progression when compared to Ctrl group. After adjustment for propensity score (PS) representing the probability of having a RAS inhibitor, ARBs (p=0.003) but not ACEIs were significantly associated with reduced progression rate of AS. On multivariable analysis including age, gender, diabetes, CAD, systolic blood pressure, Vpeak, and PS, ARBs treatment (p=0.006) was independently associated with reduced progression. All-cause mortality (mean follow-up time: 3.9±2.1yrs) was also significantly (p=0.005) higher in HTN (17%) or ACEIs (26%) groups compared to Ctrl (9%) or ARBs (8%) groups.
CONCLUSION: Systemic hypertension was associated with faster stenosis progression and increased mortality in patients with AS. ARBs but not ACEIs abolished these negative effects. These results could be explained by the fact that ARBs provide more complete blockade of inflammatory and fibro-calcific processes.
- © 2011 by American Heart Association, Inc.