Left ventricular hypertrophy and aortic stenosis: a possible role for ACE inhibition?

Aortic valve stenosis is a common cause of left ventricular hypertrophy (LVH). Severe LVH in association with aortic stenosis does not always regress following valve replacement surgery and is associated with a poor prognosis. The importance of angiotensin II in the hypertrophic process is increasingly recognised and the benefits of angiotensin-converting enzyme (ACE) inhibition in reducing LVH associated with hypertension are well established. Although ACE inhibitors are currently contraindicated in aortic stenosis (AS) on theoretical grounds there are very few data to support this. We have audited the current use of ACE inhibitors in a group of patients with AS and found that 27% of this group are currently taking an ACE inhibitor with no documented adverse effects. Trials to investigate the therapeutic benefit of ACE inhibition in preventing adverse left ventricular remodelling are merited but must be preceded by safety and tolerability studies.