{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:10:46Z","timestamp":1777421446692,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the evidence for common therapeutic controversies in the medical management of valvular heart disease (VHD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>A literature search of PubMed (inception to December 2020) was performed using the terms angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and aortic stenosis (AS); and adrenergic \u03b2-antagonists and aortic valve regurgitation (AR) or mitral stenosis (MS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection and Data Extraction:<\/jats:title>\n                    <jats:p>Randomized controlled trials (RCTs) and meta-analyses conducted in humans and published in English that reported \u22651 clinical outcome were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Synthesis:<\/jats:title>\n                    <jats:p>Nine articles were included: 3 RCTs and 1 meta-analysis for ACE inhibitors\/ARBs in AS, 1 RCT for \u03b2-blockers in AR, and 4 RCTs for \u03b2-blockers in MS. Evidence suggests that ACE inhibitors\/ARBs do not increase the risk of adverse outcomes in patients with AS but may delay valve replacement. \u03b2-Blockers do not appear to worsen outcomes in patients with chronic AR and may improve left-ventricular function in patients with a reduced ejection fraction. \u03b2-Blockers do not improve and may actually worsen exercise tolerance in patients with MS in sinus rhythm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Patient Care and Clinical Practice:<\/jats:title>\n                    <jats:p>ACE inhibitors\/ARBs and \u03b2-blockers can likely be safely used in patients with AS or AR, respectively, who have a compelling indication. There is insufficient evidence to recommend routine use of \u03b2-blockers in patients with MS without atrial fibrillation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Common beliefs about the medical treatment of VHD are not supported by high-quality data. There remains a need for larger-scale RCTs in the medical management of VHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1060028021992329","type":"journal-article","created":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T07:10:44Z","timestamp":1612595444000},"page":"1379-1385","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Therapeutic Controversies in the Medical Management of Valvular Heart Disease"],"prefix":"10.1177","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0287-898X","authenticated-orcid":false,"given":"Arden R.","family":"Barry","sequence":"first","affiliation":[{"name":"University of British Columbia, Vancouver, BC, Canada"},{"name":"Chilliwack General Hospital, Lower Mainland Pharmacy Services, Chilliwack, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica H. Z.","family":"Wang","sequence":"additional","affiliation":[{"name":"St Paul\u2019s Hospital, Lower Mainland Pharmacy Services, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,2,6]]},"reference":[{"key":"bibr1-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000659"},{"key":"bibr2-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw229"},{"key":"bibr3-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"bibr4-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.10.017"},{"key":"bibr5-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.11.002"},{"key":"bibr6-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev043"},{"key":"bibr7-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvw027"},{"key":"bibr8-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308416"},{"key":"bibr9-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(99)80585-2"},{"key":"bibr10-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a061084"},{"key":"bibr11-1060028021992329","first-page":"199","volume":"11","author":"Menadas JVM","year":"2002","journal-title":"J Heart Valve Dis"},{"key":"bibr12-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1177\/000331970205300512"},{"key":"bibr13-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.536"},{"key":"bibr14-1060028021992329","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.02.077"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1060028021992329","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1060028021992329","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1060028021992329","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:16:43Z","timestamp":1777375003000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1060028021992329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,6]]},"references-count":14,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1177\/1060028021992329"],"URL":"https:\/\/doi.org\/10.1177\/1060028021992329","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,6]]}}}