Letter Regarding Article by Rosenhek et al, “Statins but Not Angiotensin-Converting Enzyme Inhibitors Delay Progression of Aortic Stenosis”

Abstract

To the Editor: We read with interest the study by Rosenhek et al1 demonstrating a lower rate of aortic valve disease progression as indicated by Doppler echocardiographic jet velocity or valve area in patients treated with a statin but not with an angiotensin-converting enzyme (ACE) inhibitor. The authors also found that of 211 patients, 102 were receiving established treatment with ACE inhibitors. As was observed in the accompanying editorial,2 this study adds to existing published evidence that the risk of giving ACE inhibitors to patients with aortic stenosis is largely theoretical.3,4 The idea that these drugs will cause severe hypotension as a result of vasodilatation in the face of fixed left ventricular (LV) outflow obstruction appears to be either incorrect or at least describes a rare event. There are no published reports of severe hypotension or other adverse effects.3 Although ACE inhibitors do …