REVIEWS AND META-ANALYSISHypertension in aortic stenosis: a focused review and recommendations for clinical practiceSaeed, Sahraia; Scalise, Filippob; Chambers, John B.c; Mancia, GiuseppedAuthor Information aDepartment of Heart Disease, Haukeland University Hospital, Bergen, Norway bDepartment of Interventional Cardiology, Policlinico di Monza, Monza, Italy cCardiothoracic Centre, Guy's & St Thomas’ Hospital, London, United Kingdom dUniversity of Milano-Bicocca, Milano and Policlinico di Monza, Monza, Italy Correspondence to Giuseppe Mancia, University of Milano-Bicocca, Milano and Policlinico di Monza, Monza, Italy. E-mail: [email protected] Abbreviations: ACE, angiotensin-converting enzyme; ARBs, angiotensin-receptor blockers; AVR, aortic valve replacement; BP, blood pressure; CCB, calcium channel blockers; LV, left ventricle/ventricular; LVH, left ventricular hypertrophy; RAS, renin--angiotensin system; TAVI, transcutaneous aortic valve implantation Received 27 December, 2019 Revised 30 January, 2020 Accepted 17 February, 2020 Journal of Hypertension: July 2020 - Volume 38 - Issue 7 - p 1211-1219 doi: 10.1097/HJH.0000000000002426 Buy Metrics Abstract In patients with aortic stenosis, the presence of hypertension negatively affects the hemodynamic severity of the stenosis, and worsens adverse left ventricular remodeling. It accelerates the progression of the stenosis and is associated with worse prognosis. Proper management of hypertension is thus crucial but there are concerns about the safety and efficacy of antihypertensive medications as well as uncertainty about optimal blood pressure (BP) targets and their impact on left ventricular mass regression and survival benefits. In the present review, we discuss these issues based on the evidence available in the current literature. Focus is first directed on the consequences of a persistently elevated BP before and after surgical aortic valve replacement or transcatheter valve implantation, and the clinical significance of an abnormal BP response during exercise in patients with significant aortic stenosis. Available data on use of antihypertensive drugs are then critically addressed, the conclusion being that calcium channel blockers may be associated with lower survival, and that diuretics may have disadvantages in patients with left ventricular hypertrophy and smaller left ventricular cavity dimensions, β-blockers may be well tolerated and a better choice for patients with concomitant coronary artery disease and arrhythmias. Renin--angiotensin system blockers improve survival given either before or after valve intervention. Emphasis is placed on the fact that evidence is not derived from randomized trials but only from observational studies. Finally, we discuss the optimal SBP level to reach in patients with aortic stenosis. Again, randomized trials are not available but observational evidence suggests that values between 130 and 139 mmHg systolic and 70–90 mmHg diastolic might represent the best option, and lower BP targets should probably be avoided. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.