Antihypertensive Treatment in Severe Aortic Stenosis
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Previously, antihypertensive treatment in severe aortic stenosis was considered a relativecontraindication. However, recent studies have shown that antihypertensive treatment maybe safe and even beneficial in terms of reducing the progression of left ventricular pressureoverload and even retarding the progression of valvular aortic stenosis. To date, no randomizedclinical trials have been performed and no definite treatment guideline exist for the properantihypertensive regimens. Antihypertensive treatment with β-blockers has generally beenavoided in patients with severe aortic stenosis (AS) due to the concerns for inducing leftventricular dysfunction and hemodynamic compromise in the presence of severe outflow tractobstruction. Although it remains unclear whether antihypertensive treatment with a β-blockeris associated with increased risk of cardiovascular events in patients with AS, recent studies haveshown that the use of β-blockers may be safe and may even be beneficial. Renin-angiotensinsystem (RAS) are upregulated in AS and have been shown to be involved in valve calcificationand progression in both experimental models and in human trials. As such, theoretically, RASinhibition would have benefit in retarding the progression of valvular stenosis as well as havebenefit in left ventricle remodeling. Recent clinical studies are indeed showing that use of RASinhibition may be beneficial in patients with AS. Future clinical trials to establish the ideal targetblood pressure and antihypertensive regimens in severe AS is essential.
Abstract
Previously, antihypertensive treatment in severe aortic stenosis was considered a relativecontraindication. However, recent studies have shown that antihypertensive treatment maybe safe and even beneficial in terms of reducing the progression of left ventricular pressureoverload and even retarding the progression of valvular aortic stenosis. To date, no randomizedclinical trials have been performed and no definite treatment guideline exist for the properantihypertensive regimens. Antihypertensive treatment with β-blockers has generally beenavoided in patients with severe aortic stenosis (AS) due to the concerns for inducing leftventricular dysfunction and hemodynamic compromise in the presence of severe outflow tractobstruction. Although it remains unclear whether antihypertensive treatment with a β-blockeris associated with increased risk of cardiovascular events in patients with AS, recent studies haveshown that the use of β-blockers may be safe and may even be beneficial. Renin-angiotensinsystem (RAS) are upregulated in AS and have been shown to be involved in valve calcificationand progression in both experimental models and in human trials. As such, theoretically, RASinhibition would have benefit in retarding the progression of valvular stenosis as well as havebenefit in left ventricle remodeling. Recent clinical studies are indeed showing that use of RASinhibition may be beneficial in patients with AS. Future clinical trials to establish the ideal targetblood pressure and antihypertensive regimens in severe AS is essential.
참고문헌 (34)
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