title: Vasodilator therapy in patients with aortic insufficiency: a systematic review.
abstract: BACKGROUND
  The use of vasodilators to improve long-term outcomes in asymptomatic patients with chronic aortic insufficiency (AI) is controversial.
  
  
  METHODS
  We reviewed MEDLINE, PREMEDLINE, Current Contents, and Cochrane databases to identify relevant clinical trials on asymptomatic patients with chronic AI of at least moderate severity. We included those studies that involved long-term vasodilator therapy (including hydralazine, calcium-channel blockers, and angiotensin-converting enzyme inhibitors) and assessed either hemodynamic and structural parameters or clinical outcomes. Data on patient demographics, study protocols, and outcomes were abstracted.
  
  
  RESULTS
  Ten studies with 544 asymptomatic patients with chronic AI were identified. Treatment duration with vasodilators ranged from 12 weeks to 7 years. Of these, 8 studies compared vasodilators with placebo or no therapy, with 5 demonstrating improvements in at least 1 hemodynamic or structural parameter with vasodilators and 3 showing little or no apparent benefit. The remaining 2 studies directly compared outcomes between 2 different vasodilators. Both of these studies demonstrated greater improvements in hemodynamic and structural parameters with angiotensin-converting enzyme inhibitors compared with hydralazine and nifedipine. Clinical outcomes were primarily reported in only 2 of the 10 studies. Although one study suggested that the use of vasodilators slowed the rate of progression to surgery for aortic valve replacement, another showed no difference.
  
  
  CONCLUSIONS
  Vasodilators inconsistently improve hemodynamic and structural parameters in asymptomatic patients with chronic AI. In addition, the impact of vasodilators on clinical outcomes is largely uncertain and requires further study.
authors: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0366, USA. amahajer@med.umich.edu
authors: Ali
authors: A
authors: Mahajerin
authors: Hitinder S
authors: HS
authors: Gurm
authors: Thomas T
authors: TT
authors: Tsai
authors: Paul S
authors: PS
authors: Chan
authors: Brahmajee K
authors: BK
authors: Nallamothu
mesh_terms: D001022:Aortic Valve Insufficiency / Q000188:drug therapy*; D006801:Humans; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents