The largest study to date of aortic regurgitation (AR) patients suggests those with moderate to severe disease may benefit from ACE inhibitors and ARBs.
More than 2000 Scottish patients with moderate to severe AR assessed by echocardiography were included in the single-centre observational study, which used information from regional medical databases to assess morbidity and mortality.
Almost a third of the patients received an ACE inhibitor or ARB therapy, and these patients had a 44% reduced risk of all-cause mortality, a 23% reduced risk of CV events and a 32% reduced risk of AR events.
The AR event reduction was largely driven by fewer heart failure related hospitalisations and deaths, given the limited number of aortic valve replacements. The study also lacked echocardiographic follow-up data.
Writing in the Journal of the American College of Cardiology, the Scottish and Australian study authors noted previous studies had yielded inconsistent results. They said their data needed to be confirmed by a prospective randomised controlled outcome trial.
An accompanying editorial agreed, saying while the findings were insufficient to justify changes to current practice, randomised trials were justified to answer whether pharmacologic therapy could influence the natural history of severe AR.
Current guidelines suggest vasodilators be reserved for patients who are symptomatic and/or have LV dysfunction and who are not candidates for AVR, and as a short term therapy in patients who will undergo AVR.
The guidelines do not recommend therapy in the absence of systolic hypertension or in asymptomatic patients with normal LV function, given a paucity of data.
JACC 2011; 58:2084-2091