The Effect of Antihypertensive Medication Classes on the Hemodynamic Severity Parameters of Classical and Paradoxical Low-Flow, Low-Gradient Aortic Stenosis.

BACKGROUND: While the left ventricular (LV) hypertrophy and diffuse interstitial fibrosis characteristic of the pathophysiology of aortic stenosis (AS) are reversed by aortic valve replacement (AVR), the definitive treatment for AS, angiotensin modulators have demonstrated antifibrotic effects in animal models of AS. While goal-directed medical therapy (GDMT) treatment of hypertension is recommended for the early progressive stages of AS, there are no guideline-recommended antihypertensive therapies for stage D low-flow, low-gradient (LFLG) severe AS.

METHODS: All echocardiographic studies performed at South Shore University Hospital between January 2020 and December 2024 were retrospectively reviewed to identify a cohort of patients with LFLG severe AS. The progression of echocardiographic hemodynamic severity parameters was then examined according to prescribed antihypertensive medications in this cohort of 218 patients followed for a mean period of 19.1 months.

RESULTS: In this cohort, the prevalence of LFLG severe AS with preserved left ventricular ejection fraction (LVEF) was 72.9%. Angiotensin-converting enzyme (ACE) inhibitors were not associated with any statistically significant change in hemodynamic severity markers, whereas angiotensin receptor blockers (ARBs) were associated with a statistically significant increase in peak jet velocity in a subset of the cohort (p = 0.042).

CONCLUSION: In this cohort, angiotensin modulators were not associated with slower progression of AS severity parameters. Rather, the GDMT members - ​​​​sodium-glucose cotransporter 2 (SGLT2) inhibitors and beta-blockers - were associated with differential reductions in stenosis severity markers in patients with LFLG severe AS.