Medical Therapy Recommendations for Medical Therapy of Chronic AR Referenced studies that support the recommendations are summarized in Online Data Supplement 14. COR LOE Recommendations In asymptomatic patients with chronic AR (Stages B and C), treatment of hypertension (systolic blood pressure >140 mmHg) is In patients with severe AR who have symptoms and/or LV systolic dysfunction (Stages C2 and D) but a prohibitive surgical risk, GDMT for reduced LVEF with ACE inhibitors, ARBs, and/or sacubitril/valsartan is Synopsis There is no evidence that vasodilating drugs reduce se- verity of AR or alter the disease course in patients with significant AR in the absence of systemic hypertension. Recommendations for GDMT for hypertension and HF apply to patients with chronic asymptomatic AR, as for the general population. Recommendation-Specific Supportive Text 1. Severe AR is associated with a wide pulse pres- sure, such that systolic blood pressure is higher than in patients without AR even when systemic vascular resistance is normal. Transaortic stroke volume increases further with medications that lower heart rate, such as beta blockers, which may result in a paradoxical apparent increase in blood pressure. Vasodilating drugs, such as ACE inhibitors or ARBs, do not affect heart rate and thus may reduce systolic blood pressure without a substantial reduction in diastolic blood pres- sure in patients with chronic AR.1,2,5 8 2. In symptomatic patients who are candidates for surgery, medical therapy is not a substitute for AVR. However, medical therapy is help- ful for alleviating symptoms in patients who are considered to be at very high surgical risk because of concomitant comorbid medical CLINICAL STATEMENTS AND GUIDELINES 4.3.3. Timing of Intervention Recommendations for Timing of Intervention for Chronic AR Referenced studies that support the recommendations are summarized in Online Data Supplement 15 to 17. 