Vasodilators of little use with aortic insufficiency

General

Clinical Question:
Does vasodilator therapy improve long-term outcomes in patients with aortic insufficiency?

Bottom Line:
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)

Reference:
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]

Study Design:
Systematic review

Funding:
Self-funded or unfunded

Setting:
Various (meta-analysis)

Synopsis:
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.

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