Waldo, Oral

Aortic stenosis is the most common acquired valvular heart disease. Currently, there are no medications approved to slow its progression. We set out to investigate the effect of ACE inhibitors/angiotensin receptor blockers and aldosterone antagonists on the rate of progression of mild aortic stenosis. We retrospectively reviewed the charts of 2,613 patients over 45 years old, who had a peak velocity between 1.8 and 3 meters/second on initial echo. Over 8 years of followup, 491 patients were prescribed angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) and 130 patients were prescribed aldosterone receptor blockers. Patients prescribed ACE inhibitors/ARBs had a slower rate of progression of aortic stenosis compared to those not prescribed ACE inhibitors/ARBs (2.2 to 2.5 vs. 2.3 to 2.8 meters/second) (Figure 1). Also, patients prescribed aldosterone receptor blockers had a slower rate of progression of aortic stenosis compared to those who were not 2.2 to 2.4 vs. 2.3 to 2.8 meters/second) (Figure 2). Our findings suggest that angiotensin or aldosterone antagonism is associated with slower rate of progression of mild aortic stenosis.

ABSTRACTBackgroundThe panelists of the Joint National Committee recently published new recommendations for the management of hypertension. Our study aims to evaluate how current practice compares.HypothesisCurrent practice likely deviates from the recent JNC 8 panelists' recommendations.MethodsA survey was sent to cardiology providers at 3 academic medical centers: Mayo Clinic, Jacksonville, Florida; Mayo Clinic, Scottsdale, Arizona; and Mayo Clinic, Rochester, Minnesota. Providers were asked to select which blood‐pressure goal would be deemed appropriate in various cases based on individual practice in both the maintenance of patients already on therapy as well as threshold of when to initiate therapy. Comparisons with current recommendations were made, as well as geographic location and level of experience.ResultsA total of 251 survey requests were sent (May 2014), and 77 responses (30.7%) were received. Cardiologists tended not to practice according to the new guidelines, with most variation seen in patients age >60 years without comorbidities on active treatment. Providers' selection of initial pharmacologic agents in non–African American patients, African American patients, and patients with diabetes mellitus reflected congruency with guidelines.ConclusionsOur study found that clinical practice does not correlate well with the new blood‐pressure goal recommendations published by the Joint National Committee 8 panelists, particularly in patients age >60 years. Practitioners are likely to follow the recommendations in regard to pharmacologic management.