The Safety And Efficacy Related To The Use Of Renin-angiotensin System Inhibitors In Patients With Aortic Stenosis:A Systematic Review And Meta-analysis

Background: Aortic valve stenosis(AVS)is a common valvular heart disease with poor outcomes.The safety and efficacy of renin-angiotensin system inhibitors(RASI)treatments in patients with AVS remain controversial.Methods: PubMed,EMBASE and Cochrane library database were searched for this meta-analysis.The primary endpoints were all-cause mortality and cardiovascular events,while the secondary endpoints were blood pressure(BP),N-terminal B-type natriuretic peptide(NT-proBNP)and changes in echocardiographic parameters.The effect size was pooled with random-effects or fixed-effects model based on the results of statistical heterogeneity.Results: Thirteen clinical studies(including 5 randomized clinical trials and 8 retrospective cohort studies)involving 30528 patients suffering from AVS with normal or high blood pressure were included in the meta-analysis.The risk of all-cause mortality and cardiovascular events were 35%(HR: 0.65,95% CI: 0.55~0.76)and 27%(HR: 0.73;95% CI: 0.59~0.89)respectively lower in RASI-treated group than that in no-RASI group.However,the systolic BP and diastolic BP were only 2.69mmHg(WMD=-2.69 mmHg,95%CI:-3.52~-1.86)and 2.20mmHg(WMD=-2.20 mmHg,95%CI:-2.78~-1.62)lower in RASI group than that in no-RASI group.Moreover,comparing with the no-RASI group,RASI treatment also potentially decreased the left ventricular mass index(LVMI)and NT-proBNP level,and mildly increased the left ventricular ejection fraction(LVEF).Conclusions: The use of RASI in patients suffering from AVS with normal or high BP appears to be safe and leads to the significant decrease in the risk of cardiovascular events and all-cause mortality,as well as improvement of NT-proBNP,LVMI,and LVEF.