Impact of hypertension and renin–angiotensin system inhibitors in aortic stenosis

Background Experimental studies revealed that renin–angiotensin system ( RAS ) could play a crucial role in the pathophysiology of aortic stenosis ( AS ). The objectives of this study were to examine (i) the impact of hypertension on AS progression and clinical events and (ii) the effect of angiotensin‐converting enzyme inhibitors ( ACEI s) and angiotensin‐receptor blockers ( ARB s). Materials and methods In this observational study, we retrospectively analysed clinical and Doppler echocardiographic data prospectively collected in 338 patients with AS . Patients were separated into four groups: patients without hypertension and not treated by RAS medication (Ctrl group), patients with hypertension but not treated by RAS medication ( HTN group), patients treated with ACEI s, and patients treated with ARB s. AS progression rate was assessed by the annualized increase in peak aortic jet velocity. Results Compared with C trl group, patients in HTN group had faster stenosis progression ( P  = 0·01). Patients on ARB s had slower AS progression compared with C trl (trend P  = 0·10) and HTN ( P  = 0·002) groups, whereas patients on ACEI s had similar progression rate compared with C trl group ( P  =  NS ) but lower compared with HTN group ( P  = 0·02). On multivariable analysis, compared with C trl group, HTN group was associated with faster AS progression rate ( P  = 0·002), whereas ARB s with slower progression ( P  = 0·0008). During a mean follow‐up of 6·2 ± 2·4 years, HTN (hazard ratio [ HR ] = 2·45; P  = 0·006) and ACEI ( HR  = 2·30; P  = 0·01) groups were associated with a significant increase in all‐cause mortality compared with C trl group, whereas ARB group ( HR : 0·89; P  = 0·80) not. In multivariable analysis, HTN and ACEI groups remained associated with increased mortality. Conclusions Hypertension is associated with significantly faster stenosis progression and higher incidence of clinical events in patients with AS . ARB s but not ACE s were found to abolish the increased risk of mortality associated with hypertension.