Angiotensin Receptor Blockers in Aortic Stenosis

Studies support the concept that activation of the renin-angiotensin system may be involved in the progression of valve stenosis and myocardial fibrosis in aortic stenosis. Furthermore recent studies have shown that renin-angiotensin system medication may slow down aortic stenosis progression rate and left ventricle remodeling.

Thus the present study is a randomized control trial to test the efficacy of the angiotensin receptor blocker (ARB) to slow down aortic stenosis progression and left ventricular remodeling/dysfunction in patients with mild-to-moderate aortic stenosis.

Inclusion criteria

• Mild to moderate aortic stenosis (peak aortic jet velocity ≥2.5 and <4m/s)
• Normal left ventricular ejection fraction (i.e. ≥50%)
• Systolic blood pressure >110 mmHg
• Diastolic blood pressure >70 mmHg

Exclusion criteria

• More than mild aortic or mitral regurgitation, or mitral stenosis
• Current use or documented indication for renin-angiotensin system medication or Aliskiren
• Known allergy or intolerance to angiotensin II receptor blockers (ARBs)
• Alzheimer, dementia or known non-compliant patient
• Renal dysfunction (glomerular filtration rate <30ml/min/1.73m2)
• Chronic hyperkalemia
• Diagnosed hepatic failure, cirrhosis, hepatitis or history of hepatic impairment
• Newly diagnosed (<2 months) or poorly controlled diabetes
• Pre-existing obstructive coronary artery disease with CCS III-IV angina or recent myocardial infarction (<3 months)
• Pregnant or lactating women
• Patients unable to read, understand or sign research consent