COR LOE Recommendations In patients at risk of developing AS (Stage A) and in patients with asymptomatic AS (Stages B and C), hypertension should be treated according to standard GDMT, started at a low dose, and gradually titrated upward as needed, with appropriate clinical In all patients with calcific AS, statin therapy is indicated for primary and secondary prevention of atherosclerosis on the basis of standard risk scores.4 6 In patients who have undergone TAVI, renin angiotensin system blocker therapy (ACE inhibitor or ARB) may be considered to reduce the long-term risk of all-cause mortality.7,8 Benefit A In patients with calcific AS (Stages B and C), statin therapy is not indicated for prevention of hemodynamic progression of AS.4 6 Synopsis Medical treatment of hypertension and hyperlipidemia according to GDMT is appropriate for patients with AS. ACE inhibitor or ARB treatment may reduce the mortal- ity rate in patients with AS who underwent TAVI. Recommendation-Specific Supportive Text 1. Hypertension is common in patients with AS, may be a risk factor for AS, and adds to the total pres- sure overload on the LV in combination with valve obstruction. Concern that antihypertensive medi- cations might result in a decrease in cardiac output has not been corroborated in studies of medical therapy, including 2 small RCTs, likely because AS does not result in fixed valve obstruction until late in the disease process. In 1616 patients CLINICAL STATEMENTS AND GUIDELINES with asymptomatic AS in the SEAS (Simvastatin Ezetimibe in Aortic Stenosis) study, hypertension (n=1340) was associated with a 56% higher rate of ischemic cardiovascular events and a 2-fold higher mortality rate (both P<0.01) than those seen in normotensive patients with AS, although no impact on progression of valve stenosis lead- ing to symptoms requiring AVR was seen. 