La Trobe

File(s) stored somewhere else

Please note: Linked content is NOT stored on La Trobe and we can't guarantee its availability, quality, security or accept any liability.

Antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis

journal contribution
posted on 2020-12-15, 02:00 authored by J Sen, E Chung, C Neil, Thomas MarwickThomas Marwick
© Background Hypertension confers a poor prognosis in moderate or severe aortic stenosis (AS), however, antihypertensive therapy (AHT) is often not prescribed due to the perceived deleterious effects of vasodilation and negative inotropes. Objective To assess the efficacy and safety outcomes of AHT in adults with moderate or severe AS. Design Systematic review and meta-Analysis. Data sources The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and grey literature were searched without language restrictions up to 9 September 2019. Study eligibility criteria, appraisal and synthesis methods Two independent reviewers performed screening, data extraction and risk of bias assessments from a systematic search of observational studies and randomised controlled trials comparing AHT with a placebo or no AHT in adults with moderate or severe AS for any parameter of efficacy and safety outcomes. Conflicts were resolved by the third reviewer. Meta-Analysis with pooled effect sizes using random-effects model, were estimated in R. Main outcome measures Mortality, Left Ventricular (LV) Mass Index, systolic blood pressure, diastolic blood pressure and LV ejection fraction Results From 3025 publications, 31 studies (26 500 patients) were included in the qualitative synthesis and 24 studies in the meta-Analysis. AHT was not associated with mortality when all studies were pooled, but heterogeneity was substantial across studies. The effect size of AHT differed according to drug class. Renin-Angiotensin-Aldosterone system inhibitors (RAASi) were associated with reduced risk of mortality (Pooled HR 0.58, 95% CI 0.43 to 0.80, p=0.006), The differences in changes of haemodynamic or echocardiographic parameters from baseline with and without AHT did not reach statistical significance. Conclusion AHT appears safe, is well tolerated. RAASi were associated with clinical benefit in patients with moderate or severe AS.


This work has been supported in part by a Partnership grant (1149692) from the National Health and Medical Research Council, Canberra. JS was supported by scholarships from the National Heart Foundation of Australia (ID: 102578), National Health and Medical Research Council of Australia (ID: 1191044).


Publication Date



BMJ Open





Article Number



16p. (p. 1-16)


BMJ Group



Rights Statement

The Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.