ARBs in Patients with Severe Aortic Stenosis for Blood Pressure Control

Rationale for Using ARBs in Aortic Stenosis

Hypertension in aortic stenosis creates "2 resistors in series," increasing complications and cardiovascular mortality, making blood pressure control essential 1, 2
Renin-angiotensin system (RAS) blockade with ARBs may be advantageous in aortic stenosis due to potentially beneficial effects on LV fibrosis, control of hypertension, reduction of dyspnea, and improved effort tolerance 1, 2
There is no evidence that antihypertensive medications, including ARBs, produce an inordinate degree of hypotension in patients with aortic stenosis when used appropriately 1, 2

Start with a low dose of ARB and gradually titrate upward as needed to control blood pressure 1, 2
Monitor blood pressure closely during initiation and dose adjustments 2, 4
Consider co-management with a cardiologist, especially in patients with moderate to severe aortic stenosis 1, 2, 4

Beta blockers may be appropriate for patients with aortic stenosis who have reduced ejection fraction, prior MI, arrhythmias, or angina pectoris 1, 2, 5
Diuretics should be used sparingly in patients with small LV chamber dimensions to avoid excessive preload reduction 1, 2, 4

Avoid excessive blood pressure reduction that could compromise coronary perfusion, especially in patients with LV hypertrophy 2
Monitor for symptoms of hypotension, particularly during initiation and dose adjustments 2, 4
Consider the need for aortic valve replacement in appropriate candidates as definitive therapy rather than focusing solely on medical management 6, 4