7. Which of the following has been shown to delay the need for mitral valve repair or replacement in the setting of severe mitral regurgitation?

A. Beta-blockers

B. Angiotensin converting enzyme inhibitors

C. Non-dihydropyridine calcium channel blockers

D. Hydralazine

E. None of the above

No pharmacotherapy exists that can delay the need for mitral valve repair or replacement in the setting of severe mitral valve regurgitation.

Pharmacotherapy directed at afterload reduction with vasodilators can be useful during acute decompensated heart failure in people with severe MR, however chronic vasodilator therapy is indicated only for non-surgical candidates.

Vasodilator therapy is generally not indicated for asymptomatic patients with chronic MR due to lack of data showing benefit and the possibility of masking symptoms that may indicate a need for surgical intervention. However, when another indication arises such as hypertension or diabetes mellitus, the use of vasodilators such as ACE inhibitors or angiotensin receptor blockers is accepted.

Symptomatic patients that are not surgical candidates have been shown to benefit from therapy with vasodilators. ACE inhibitors in combination with nitrates is considered the combination of choice in patients with MR from ischemic heart disease or dilated cardiomyopathy, however in patients with MR from MVP, reducing only preload actually increases regurgitation. Thus it is recommended to treat MR from MVP with beta-blockers and diuretics.