Vasodilators of little use with aortic insufficiencyDoes vasodilator therapy improve long-term outcomes in patients with aortic insufficiency?Treatment with an angiotensin-converting enzyme inhibitor, hydralazine, or nifedipine (Procardia) does not consistently improve hemodynamic parameters in patients with aortic insufficiency (AI). With the exception of one small study showing a benefit with nifedipine, treatment does not slow the progression of AI as measured by rates of aortic valve replacement. (LOE = 1a)Mahajerin A, Gurm HS, Tsai TT, Chan PS, Nallamothu BK. Vasodilator therapy in patients with aortic insufficiency: A systematic review. Am Heart J 2007;153:454-461. [PMID:17383279]To conduct this systematic review, the researchers searched 4 databases and the references of retrieved articles and recent review articles for English-language randomized studies of patients with AI of at least moderate severity but with normal left ventricular function. The 10 studies included in the review evaluated a total of 544 patients. Patients treated with nifedipine had a significantly lower rate of progression to atrial valve replacement than patients treated with digoxin (15% vs 34%; P < .001) in one small study. Other vasodilators, including angiotensin-converting enzyme inhibitors and hydralazine, have not been shown to reduce the need for replacement. Hemodynamic parameters -- such as blood pressure, ejection fraction, and others -- were not consistently improved with treatment. Harm due to treatment was not found, though the studies may not have had enough power to identify harmful effects if they exist.
Vasodilators of little use with aortic insufficiency
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