In this discussion, the latest European guidelines on valvular heart disease take center stage. The conversation dives into the debate around treating asymptomatic aortic stenosis and unpacks the complexities of surgical interventions. A breakthrough drug, Baxdrostat, is scrutinized for its potential to revolutionize treatment for resistant hypertension. Additionally, recent trials on myosin inhibitors offer fresh hope for patients battling hypertrophic cardiomyopathy and heart failure, showcasing new therapies that challenge traditional approaches.
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question_answer ANECDOTE
Correction From Copenhagen
Mandrola corrected an earlier error: the Dan Block reboot trial randomized 8,000 patients, not 4,000.
He also relays Professor Eva Prescott's point that beta blockers may still help patients with EF 40–49% despite modest absolute benefit.
volunteer_activism ADVICE
Stop Routine Add-On Surgical AF Ablation
Avoid routine surgical AF ablation add-ons without robust RCT evidence and randomized data.
Mandrola would stop the add-on billing code unless patients enroll in trials to prevent unproven overuse.
insights INSIGHT
Aldosterone Synthase Inhibitors Lower BP Well
Baxdrostat (aldosterone synthase inhibitor) lowered systolic BP by ~9–10 mmHg versus placebo in resistant hypertension trials.
Mandrola cautions many trial patients were not on MRAs, so incremental benefit over cheap spironolactone may be smaller and hyperkalemia is a concern.
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More from ESC including: Valvular HD guidelines, a new drug class for HTN, myosin inhibition in HCM, vericiguat, and digoxin are the topic discussed by John Mandrola, MD.
This podcast is intended for healthcare professionals only.
To read a partial transcript or to comment, visit:
https://www.medscape.com/twic
I New European Valvular Heart Disease Guidelines
2025 ESC/EACTS Guidelines for the management of valvular heart disease https://doi.org/10.1093/eurheartj/ehaf194
Debate: Does Asymptomatic Aortic Stenosis Warrant Early Intervention? https://exp.medscape.com/debates/does-asymptomatic-aortic-stenosis-warrant-early-intervention/
Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa1500528
Surgical ablation of atrial fibrillation: a systematic review and meta-analysis https://doi.org/10.1093/europace/eux336
II New Drug for Resistant HTN
Baxdrostat: A 'Game Changer' for Hypertension? https://www.medscape.com/viewarticle/baxdrostat-game-changer-hypertension-2025a1000mz7
Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2507109
Lorundrostat Efficacy and Safety in Patients with Uncontrolled Hypertension https://www.nejm.org/doi/10.1056/NEJMoa2501440
III HCM News at ESC
New Trials Clarify Role of Myosin Inhibitors for Hypertrophic Cardiomyopathy https://www.medscape.com/viewarticle/new-trials-clarify-role-myosin-inhibitors-hypertrophic-2025a1000myv
MAPLE HCM https://www.nejm.org/doi/full/10.1056/NEJMoa2504654
New Data Said to Support Vericiguat as Standard Therapy for Heart Failurehttps://www.medscape.com/viewarticle/new-data-said-support-vericiguat-standard-therapy-heart-2025a1000mz9
VICTOR https://doi.org/10.1016/S0140-6736(25)01665-4
VICTORIA https://www.nejm.org/doi/full/10.1056/NEJMoa1915928
An individual participant data analysis of the VICTORIA and VICTOR trials https://doi.org/10.1016/S0140-6736(25)01682-4
V More on Digoxin
RATE AF substudy https://doi.org/10.1002/ejhf.70022
Main RATE-AF trial https://jamanetwork.com/journals/jama/fullarticle/2774407
Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis https://doi.org/10.1016/S0140-6736(14)61373-8
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