Table.

Effects of drugs on functional measures, progression and clinical outcomes of VHD.

	AS	AR	MS	MR	TR
ACEi/ARB	RCT: +*; OS: + ; DNR	RCT: −; OS: + ; DNR	N	RCT: N; OS: +; DNR	N
Beta-blockers	N	BA, F; DNR	F	BA, F; DNR	N
Bisphosphonates	RCTs: N; OS:±; DNR	N	N	N	N
Hydralazine	N	F, DNR	N	N	N
MRAs	N	N	N	N	N
Nitrates	F	F; DNR	N	F; DNR	N
Nifedipine	N	+ **	N	N	N
Statin	RCTs: −; DNR	N	N	N	N

VHD: valvular heart diseases; AS: aortic stenosis; AR: aortic regurgitation; MS: mitral stenosis; MR: mitral regurgitation; TR: tricuspid regurgitation; ACEi: angiotensin converting enzyme inhibitors; ARB: angiotensin receptor blockers; MRA: mineralocorticoid receptor antagonists; RCT: randomized controlled trials; OS: observational studies; N: not studied/insufficient data; +: benefit; −: no benefit; ±: mixed/inconsistent results on clinical natural history; BA : beneficial effects in animal models only; F: short-term hemodynamic/functional benefits in humans, no long-term data DNR: do not recommend

^*RCT benefit for exercise tolerance only; no natural history outcome data

^**RCT benefit for progression/natural history apparently only for hypertensive patients