Prognostic impact of renin angiotensin aldosterone system inhibitor in hypertensive patients undergoing transcatheter aortic valve implantation

Objective: The purpose of this study was to determine the prognostic impact of baseline treatment with RAAS inhibitors (RAASi) on all-cause mortality in a population of patients with severe AS who underwent transcatheter aortic valve implantation (TAVI). Design and method: The study included 373 patients with AS who had undergone TAVI. Analyses were undertaken on the subgroup of hypertensive individuals (n 327) with 2 years of follow-up. Clinical characteristics were compared using Kruskal-Wallis non-parametric test for independent samples and study-stratified multivariable Cox proportional hazards regression models was built according to baseline RAASi therapy status. A second analysis was undertaken by categorizing patients receiving RAASi medication (n 222) into those receiving angiotensin II receptor blockers (ARBs) (n 110) and those receiving angiotensin-converting enzyme inhibitors (ACEi) (n 112). Results: Taking RAASi at baseline in the hypertensive patients group was significantly related to gender (Women 56,8%), heart failure (25,7%), chronic kidney disease (CKD) (25,7%), atrial fibrillation (AF) (19,4), being on calcium-channel blocker (26,6%) or anti-platelet therapy (68,5%) (all p < 0,05). All-cause mortality occurred in 23 (10,4%) of the patients on RAASi, 9 (8,2%) on ARBs and 14 (12,4%) on ACEi. In univariate COX regression model treatment with a RAASi was related with a reduction in 2-year all-cause mortality (EXP 0.46, p 0.011). After multivariable correction for significant confounders the association was not statistically significant (p = 0.08). Analyzing ACEi ARBs separately baseline ARB therapy was associated with significant reduction in all-cause mortality (EXP 0.44, p 0.028) (Figure) that was confirmed in multivariate analysis (EXP 0.42, p 0.038) with no impact in baseline ACEi use (Table). Heart failure (EXP 2.87, p < 0.001), atrial fibrillation (EXP 2.39, p 0.005) and chronic kidney disease (EXP 2.08, p 0.02) were all related with an increased 2-year all-cause mortality, but after multivariable correction only heart failure remained statistically significant. Conclusions: ARBs, but not ACEi, are independently associated with a decreased risk of 2-year all-cause death in a cohort of hypertensive patients with severe AS who underwent TAVI. While it is true that these results have molecular basis, additional research is required to corroborate these findings.