Although RAS blockade in theory is the treatment of choice for hypertension in patients with prior AF, relative to other classes of agents, all of the trials that have shown clinical superiority of ARBs over other agents were comparisons with CCBs or beta blockers that are no longer recommended as first-line agents for treatment of hypertension.S9.8-2 There are no available trials comparing ACE inhibitors with other drugs or any RAS-blocking agents with diuretics. 9.9. Valvular Heart Disease Recommendations for Treatment of Hypertension in Patients With Valvular Heart Disease References that support recommendations are summarized in Online Data Supplements 49 and 50. COR LOE Recommendations I B-NR 1. In adults with asymptomatic aortic stenosis, hypertension should be treated with pharmacotherapy, starting at a low dose and gradually titrating upward as IIa C-LD 2. In patients with chronic aortic insufficiency, treatment of systolic hypertension with agents that do not slow the heart rate (ie, avoid beta blockers) is reasonable.S9.9-5,S9.9-6 Recommendation-Specific Supportive Text 1. Hypertension is a risk factor for the development of aortic stenosis (stage A [eg, aortic sclerosis or bicuspid aortic valve]) and asymptomatic aortic stenosis (stage B [progressive asymptomatic aortic stenosis]). The combi- nation of hypertension and aortic stenosis, 2 resistors in series, increases the rate of complications. In patients with asymptomatic mild-to-moderate aortic stenosis, hypertension has been associated with more abnormal LV structure and increased cardiovascular morbidity and There is no evidence that antihypertensive medications will produce an inordinate degree of hypo- tension in patients with aortic stenosis. Nitroprusside infusion in hypertensive patients with severe aortic ste- nosis lowers pulmonary and systemic resistance, with improvements in stroke volume and LV end-diastolic Thus, careful use of antihypertensive agents to achieve BP control in patients with hypertension and aortic stenosis is beneficial. 