causes of aortic stenosis

"This study suggests an important benefit of renin-angiotensin system inhibition in patients with aortic stenosis, which might seem like heresy," according to Gerard Aurigemma, MD, and John Keaney Jr., MD, of the University of Massachusetts Medical School in Worcester.

"There has been a long-standing concern that vasodilation in the face of fixed left ventricular outflow obstruction is contraindicated and life threatening," they noted in an accompanying editorial.

But Lang and colleagues wrote that the concern about severe hypotension as a result of vasodilation "describes a rare event and does not appear to be very well substantiated by clinical evidence."

They cautioned, however, that their retrospective, observational analysis could not prove that the ACE inhibitors and ARBs were responsible for the lower rates of death and cardiovascular events.

"Prospective, randomized, controlled trials are warranted to confirm these findings," they wrote.

The renin-angiotensin system is activated early on in aortic stenosis, leading to the development of left ventricular hypertrophy, myocardial fibrosis, myocardial contractile failure, and diastolic dysfunction, according to the researchers.

Although clinical studies have shown that inhibitors of the renin-angiotensin system help resolve some of these issues, the use of such agents has been considered to be relatively contraindicated in patients with aortic stenosis, they noted.

To explore whether ACE inhibitors and ARBs might help patients with aortic stenosis, Lang and colleagues examined data on 2,117 patients with aortic stenosis (mean age 73) from an echocardiography database that included prescribing, morbidity, and mortality information for the population of Tayside, Scotland.