Effects of angiotensin converting enzyme inhibitors in hypertensive patients with aortic valve stenosis: a drug withdrawal study.
OBJECTIVE
To determine the effects of angiotensin converting enzyme (ACE) inhibitors in hypertensive patients with aortic valve stenosis (AS).


METHODS
Observational, drug withdrawal, single blinded study, with randomisation of the order of tests.


METHODS
Hypertension and asymptomatic AS.


METHODS
20 patients (aged 73 (9) years, valve area 0.7 (0.3) cm2, left ventricular ejection fraction > or = 45%) were enrolled. Each patient underwent two sets of tests (with and without taking the drug), each of which included clinical evaluation, Doppler echocardiogram, and symptom limited exercise echocardiography.


METHODS
Functional and haemodynamic variables while taking and not taking ACE inhibitors.


RESULTS
Drug intervention induced no change in patients' subjective functional class. While taking ACE inhibitors, patients had a lower systolic blood pressure (140 (18) mm Hg with ACE inhibitors v 159 (12) mm Hg without ACE inhibitors, p = 0.02), a higher mean pressure gradient (34 (15) mm Hg v 28 (18) mm Hg, p = 0.037), and a higher left ventricular stroke work loss (19 (6)% v 14 (10)%, p = 0.009). Other baseline functional and haemodynamic parameters were unmodified. Five patients had an abnormal blood pressure response during one of the exercise tests (two patients while taking the drug and three patients while not taking the drug). When taking ACE inhibitors, patients had a higher stroke volume at peak stress (59 (11) ml v 54 (25) ml, p = 0.046). All other stress variables remained constant.


CONCLUSIONS
In AS, the afterload relief caused by ACE inhibitors is blunted by a parallel increase in the pressure gradient. However, ACE inhibitors favourably affect stress haemodynamic function in most hypertensive patients with AS and should not be discontinued.
Jiménez-Candil
J
J
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Bermejo
J
J
Yotti
R
R
Cortina
C
C
Moreno
M
M
Cantalapiedra
J L
JL
García-Fernández
M A
MA
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001024:Aortic Valve Stenosis / Q000150:complications*; D001794:Blood Pressure / Q000502:physiology; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors