Do RAS inhibitors reduce mortality in patients undergoing TAVR for aortic stenosis?

RAS inhibitors (drugs like ACE inhibitors or ARBs) are commonly used for high blood pressure and heart failure. After transcatheter aortic valve replacement (TAVR) for aortic stenosis, doctors often prescribe them. Research suggests these medications may help patients live longer and have fewer heart-related problems after the procedure.

What the research says

Several large studies have looked at whether RAS inhibitors reduce death risk after TAVR. A meta-analysis of 9 observational studies including over 36,000 patients found that RAS inhibitor use was linked to 26% lower odds of death from any cause and 38% lower odds of death from heart problems ¹. Another meta-analysis of 12 studies with nearly 36,000 patients confirmed these benefits, with a high probability of clinically meaningful risk reduction ³⁷. A Swedish study of 4,668 heart failure patients who had aortic valve replacement (including TAVR) showed that RAS inhibitors were associated with lower all-cause death in both those with reduced and preserved heart pumping function ⁵. Even in patients who had heart muscle injury during TAVR, RAS inhibitors were linked to fewer cardiovascular deaths at one year ⁶. However, these findings come from observational studies, not randomized trials, so they cannot prove cause and effect. The evidence is consistent across many studies, but individual patient factors matter.

What to ask your doctor

• Should I start or continue taking a RAS inhibitor (ACE inhibitor or ARB) after my TAVR procedure?
• What are the potential benefits of RAS inhibitors for my specific heart condition?
• Are there any risks or side effects I should watch for with RAS inhibitors?
• How does my kidney function and blood pressure affect whether RAS inhibitors are right for me?
• If I already take a RAS inhibitor, should I continue it long-term after TAVR?