ACE inhibition in aortic stenosis: dangerous medicine or golden opportunity?

Journal of Human Hypertension
H C Routledge, J N Townend

Abstract

Conventionally angiotensin-converting enzyme (ACE) inhibitors are contraindicated in patients with aortic stenosis. Abundant evidence is now available showing that angiotensin II has a central role in the development of left ventricular hypertrophy (LVH), myocardial contractile failure and diastolic dysfunction in response to pressure overload. In animal models, ACE inhibitors have been shown to attenuate these pathological responses. In humans there is no such evidence available, however uncontrolled studies have shown that these agents are not only tolerated but are associated with acute improvements in haemodynamics and diastolic function. Further studies are merited to assess the possible role of ACE inhibitors in aortic stenosis both before and after valve replacement. Potential benefits may include prevention of LVH, improved diastolic function, reduction of arrhythmias and preservation of left ventricular function.

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Citations

Oct 22, 2010·International Journal of Clinical Practice. Supplement·B R Lindman, M M Chakinala
Mar 5, 2009·BMC Cardiovascular Disorders·Mikko A SimolinPetri T Kovanen
Sep 9, 2004·Circulation·Nalini M Rajamannan, Catherine M Otto
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Oct 15, 2013·European Journal of Clinical Investigation·Romain CapouladePhilippe Pibarot
Apr 13, 2004·American Heart Journal·Anand ChockalingamUNKNOWN Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis
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Jun 6, 2006·Journal of the American College of Cardiology·Catherine M Otto
Aug 11, 2011·Journal of Cardiovascular Pharmacology and Therapeutics·Maria J SalasGervasio A Lamas

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