Aortic stenosis medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==


* [[Hypertension]] is common in [[patients]] with [[AS]], may be a risk factor for [[AS]], and increases the total [[pressure overload]] on the [[left ventricle]] in combination with [[valve]] obstruction.
* [[Hypertension]] is common in [[patients]] with [[AS]], may be a risk factor for [[AS]], and increases the total [[pressure overload]] on the [[left ventricle]] in combination with [[valve]] obstruction.<ref name="pmid31290937">{{cite journal |vauthors=Nazarzadeh M, Pinho-Gomes AC, Smith Byrne K, Canoy D, Raimondi F, Ayala Solares JR, Otto CM, Rahimi K |title=Systolic Blood Pressure and Risk of Valvular Heart Disease: A Mendelian Randomization Study |journal=JAMA Cardiol |volume=4 |issue=8 |pages=788–795 |date=August 2019 |pmid=31290937 |pmc=6624812 |doi=10.1001/jamacardio.2019.2202 |url=}}</ref>
* 2 small [[RCTs]] have not confirmed that [[antihypertensive]] [[ medications]] may reduce the [[cardiac output]] because [[AS]] does not result in fixed [[valve]] obstruction until late stage in the disease.
* 2 small [[RCTs]] have not confirmed that [[antihypertensive]] [[ medications]] may reduce the [[cardiac output]] because [[AS]] does not result in fixed [[valve]] obstruction until late stage in the disease.
* The study of asymptomatic [[AS]] showed the association of [[hypertension]] with higher rate of [[ischemic cardiovascular]] events and a 2-fold higher [[mortality rate]] ) than  normotensive [[patients]] with [[AS]]. However, impact on progression of valve stenosis leading to [[symptoms]] requiring [[AVR]] was not observed.
* The study of asymptomatic [[AS]] showed the association of [[hypertension]] with higher rate of [[ischemic cardiovascular]] events and a 2-fold higher [[mortality rate]] ) than  normotensive [[patients]] with [[AS]]. However, impact on progression of valve stenosis leading to [[symptoms]] requiring [[AVR]] was not observed.
* [[Medical therapy]] for [[hypertension]] is based on the standard guidelines, initiating at a low dose and gradually titrating upward as needed to controlling of [[blood pressure]].
* [[Medical therapy]] for [[hypertension]] is based on the standard guidelines, initiating at a low dose and gradually titrated upward as needed to controlling of [[blood pressure]].
* There are no studies considering specific [[antihypertensive]] medications in [[patients]] with [[AS]], but [[diuretics]] may reduce [[stroke volume]], particularly if the [[LV]] chamber is small at baseline.  
* There are no studies considering specific [[antihypertensive]] medications in [[patients]] with [[AS]], but [[diuretics]] may reduce [[stroke volume]], particularly if the [[LV]] chamber is small at baseline.  
* The advantages of [[ACE inhibitors]] including beneficial effects on [[LV fibrosis]], control of [[hypertension]].  
* The advantages of [[ACE inhibitors]] including beneficial effects on [[LV fibrosis]], control of [[hypertension]].  

Revision as of 13:07, 30 June 2022



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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Usama Talib, BSc, MD [4] Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]; Rim Halaby, M.D. [6]

Overview

While medical therapy may improve the symptoms of patients with aortic stenosis (AS), medical therapy does not prolong life expectancy. Aortic valve replacement (AVR) remains the definitive treatment of symptomatic aortic stenosis and it improves both the symptoms and life expectancy of patients with aortic stenosis. When pharmacological therapies are used, extreme caution must be taken in the administration of vasodilators as excess vasodilation may lead to hypotension, a reduction in perfusion pressure to the heart, a further decline in cardiac output and further hypotension. This downward spiral can be fatal and must be avoided at all costs.[1][2]

Medical Therapy

References

  1. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.
  2. Otto CM (2006). "Valvular aortic stenosis: disease severity and timing of intervention". J Am Coll Cardiol. 47 (11): 2141–51. doi:10.1016/j.jacc.2006.03.002. PMID 16750677.
  3. Nazarzadeh M, Pinho-Gomes AC, Smith Byrne K, Canoy D, Raimondi F, Ayala Solares JR, Otto CM, Rahimi K (August 2019). "Systolic Blood Pressure and Risk of Valvular Heart Disease: A Mendelian Randomization Study". JAMA Cardiol. 4 (8): 788–795. doi:10.1001/jamacardio.2019.2202. PMC 6624812 Check |pmc= value (help). PMID 31290937.

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