From the Guidelines
Non-dihydropyridine calcium channel blockers, such as diltiazem and verapamil, should be avoided in patients with valvular heart disease, particularly those with left ventricular dysfunction, due to their negative inotropic properties and potential to worsen heart failure symptoms. When managing hypertension in patients with valvular heart disease, it is crucial to consider the potential impact of antihypertensive medications on cardiac output and hemodynamics.
- Medications that decrease contractility, such as non-dihydropyridine calcium channel blockers, can precipitate heart failure in patients with valvular disease, especially those with left ventricular dysfunction 1.
- Centrally acting norepinephrine-depleting agents, like clonidine, may also need to be avoided or used with caution in patients with valvular heart disease and heart failure, given the increased mortality associated with similar agents, such as moxonidine, in patients with heart failure 1.
- Potent direct-acting vasodilators, such as minoxidil, should be avoided due to their renin-related salt and fluid-retaining effects, which can exacerbate heart failure symptoms 1.
- In contrast, dihydropyridine calcium channel blockers, such as amlodipine, have been shown to be safe in patients with severe heart failure, making them a potentially suitable option for managing hypertension in patients with valvular heart disease 1.
From the FDA Drug Label
The “hyperdynamic” circulation caused by hydrALAZINE may accentuate specific cardiovascular inadequacies. For example, hydrALAZINE may increase pulmonary artery pressure in patients with mitral valvular disease.
Hydralazine is an antihypertensive to avoid in valvular heart disease, specifically in patients with mitral valvular disease, as it may increase pulmonary artery pressure 2.
From the Research
Antihypertensive Medications to Avoid in Valvular Heart Disease
There are no specific antihypertensive medications mentioned in the provided studies as those to avoid in valvular heart disease. However, the following points can be considered:
- The management of valvular heart disease involves a comprehensive approach, including diagnosis, medical therapy, and surgical or catheter interventions 3.
- The choice of medical therapy, including antihypertensive medications, should be individualized based on the specific type and severity of valvular heart disease, as well as the presence of other comorbidities 4.
- The American College of Cardiology/American Heart Association guidelines provide recommendations for the diagnosis and management of valvular heart disease, including the use of medical therapy 3.
- Recent advancements in the field of valvular heart disease have led to a greater understanding of the pathophysiology and therapeutic approaches, including the use of transcatheter therapies 5.
- The management of patients with valvular heart disease should be done by a heart team, including cardiologists and cardiac surgeons, to ensure optimal care 4.