Datasheet1_Renin–angiotensin system inhibitors reduce cardiovascular mortality in hypertensive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry.docx

ObjectivesArterial hypertension is associated with the triggering of the renin–angiotensin system, leading to left ventricle fibrosis and worse cardiovascular outcomes. In this study, patients with comorbid arterial hypertension and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) were selected from the EffecTAVI registry to evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on cardiovascular mortality.
MethodsWe enrolled 327 patients undergoing TAVI from the EffecTAVI registry. Using Kaplan–Meier event rates and study-stratified multivariable Cox proportional hazards regression models, we evaluated 2-year clinical outcomes according to the ACEI/ARB therapy status at enrollment.
ResultsAmong the included patients, 222 (67.9%) were on ACEIs/ARBs at baseline, whereas 105 (32.1%) were not. Treatment with ACEIs/ARBs was significantly associated with a 2-year decrease in the rate of cardiovascular mortality (HR = 0.44, 95% CI: 0.23–0.81, p = 0.009). This association remained stable after both multivariable adjustment and propensity score matching.
ConclusionIn a cohort of hypertensive patients with severe AS who were selected from the EffecTAVI registry, ACEI/ARB treatment at baseline was found to be independently associated with a lower risk of 2-year cardiovascular mortality, suggesting a potential benefit of this treatment. More trials are needed to validate this finding and to understand the full benefit of this treatment.

研究目的：动脉高血压可触发肾素-血管紧张素系统（renin-angiotensin system），进而导致左心室纤维化及不良心血管预后。本研究从EffecTAVI注册队列中纳入合并动脉高血压与重度主动脉瓣狭窄（aortic stenosis, AS）且接受经导管主动脉瓣置换术（transcatheter aortic valve implantation, TAVI）的患者，旨在评估血管紧张素转换酶抑制剂（angiotensin-converting enzyme inhibitors, ACEIs）或血管紧张素Ⅱ受体拮抗剂（angiotensin II receptor blockers, ARBs）对心血管死亡率的影响。
研究方法：我们从EffecTAVI注册队列中纳入327例接受TAVI的患者。采用Kaplan-Meier事件发生率及研究分层的多变量Cox比例风险回归模型，根据入组时的ACEI/ARB治疗状态，评估患者的2年临床结局。
研究结果：纳入的患者中，222例（67.9%）基线时接受ACEI/ARB治疗，105例（32.1%）未接受该治疗。ACEI/ARB治疗与2年心血管死亡率的显著降低存在相关性（风险比（HR）=0.44，95%置信区间（CI）：0.23–0.81，p=0.009）。该相关性在多变量校正及倾向得分匹配后仍保持稳定。
研究结论：在从EffecTAVI注册队列中选取的合并重度主动脉瓣狭窄的高血压患者队列中，基线时的ACEI/ARB治疗与更低的2年心血管死亡率风险独立相关，提示该治疗存在潜在获益。未来仍需开展更多试验以验证该发现，并明确该治疗的全部获益。