Trial reportEuropean heart journal. Cardiovascular Imaging2015
A prospective, double-blind, randomized controlled trial of the angiotensin-converting enzyme inhibitor Ramipril In Aortic Stenosis (RIAS trial).
Trial report in European heart journal. Cardiovascular Imaging, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03201185 (Beneficio Del Bloqueo Del Sistema Renina-angiotensina Sobre la evolución clínica y el Remodelado Ventricular Tras la colocación de Una prótesis percutánea aórtica), which is not on this map. Cited by 64 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Beneficio Del Bloqueo Del Sistema Renina-angiotensina Sobre la evolución clínica y el Remodelado Ventricular Tras la colocación de Una prótesis percutánea aórtica (RASTAVI)
Who cites it
64 citing papers in PubMed, 7 syntheses or guidelines pooled it, 134 citations in OpenAlex.
- Pharmacotherapy for hypertension in adults 60 years or older.The Cochrane database of systematic reviews · 2025Pooled it
- The clinical outcomes of reni-angiotensin system inhibitors for patients after transcatheter aortic valve replacement: A systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Association of renin-angiotensin system inhibitors use with short- and long-term mortality in patients with aortic stenosis: A systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Therapeutic Controversies in the Medical Management of Valvular Heart Disease.The Annals of pharmacotherapy · 2021Pooled it
- Antihypertensive therapies in moderate or severe aortic stenosis: a systematic review and meta-analysis.BMJ open · 2020Pooled it
- Pharmacotherapy for hypertension in adults 60 years or older.The Cochrane database of systematic reviews · 2019Pooled it
- Effects of the coronary artery disease associated LPA and 9p21 loci on risk of aortic valve stenosis.International journal of cardiology · 2019Pooled it
- Impact of renin-angiotensin system inhibitors on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis of from the PARTNER 2 trial and registries.European heart journal · 2020Trial
- A prospective, double-blind, randomized controlled trial of the angiotensin-converting enzyme inhibitor Ramipril In Aortic Stenosis (RIAS trial).European heart journal. Cardiovascular Imaging · 2015Trial
- From biomechanical mechanisms to clinical reasoning: Deciphering mechanobiological drivers of aortic valve calcification for precision therapy.Mechanobiology in medicine · 2026Review
- Contemporary Management of Aortic Stenosis: Timing of Intervention and Lifetime Valve Management.European journal of clinical investigation · 2026Review
- Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Interplay between medical and interventional therapies in valvular heart disease and heart failure: an expert opinion paper.ESC heart failure · 2026Review
- Article
- Tracking progression of aortic stenosis with echocardiography.Echo research and practice · 2025Article
- Sodium-Glucose Cotransporter 2 Inhibitors in Aortic Stenosis: Toward a Comprehensive Cardiometabolic Approach.International journal of molecular sciences · 2025Review
- Current Management and Therapy of Severe Aortic Stenosis and Future Perspective.Journal of atherosclerosis and thrombosis · 2024Review
- Review
- Human Aortic Stenotic Valve-Derived Extracellular Vesicles Induce Endothelial Dysfunction and Thrombogenicity Through AT1R/NADPH Oxidases/SGLT2 Pro-Oxidant Pathway.JACC. Basic to translational science · 2024Article
- [Conservative treatment of valvular heart disease in adults].Innere Medizin (Heidelberg, Germany) · 2024Review
4 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
aimsAngiotensin-converting enzyme (ACE) inhibitors improve left ventricular (LV) remodelling and outcome in heart failure and hypertensive heart disease. They may be similarly beneficial in patients with aortic stenosis (AS), but historical safety concerns have limited their use, and no prospective clinical trials exist. METHODS AND
resultsWe conducted a prospective, randomized, double-blind, placebo-controlled trial in 100 patients with moderate or severe asymptomatic AS to examine the physiological effects of ramipril, particularly LV mass (LVM) regression. Subjects were randomized to ramipril 10 mg daily (n = 50) or placebo (n = 50) for 1 year, and underwent cardiac magnetic resonance, echocardiography, and exercise testing at 0, 6, and 12 months, with follow-up data available in 77 patients. There was a modest but progressive reduction in LVM (the primary end point) in the ramipril group vs. the placebo group (mean change -3.9 vs. +4.5 g, respectively, P = 0.0057). There were also trends towards improvements in myocardial physiology: the ramipril group showed preserved tissue Doppler systolic velocity compared with placebo (+0.0 vs. -0.5 cm/s, P = 0.04), and a slower rate of progression of the AS (valve area 0.0 cm(2) in the ramipril group vs. -0.2 cm(2) in the placebo arm, P = 0.067). There were no significant differences in major adverse cardiac events.
conclusionACE inhibition leads to a modest, but progressive reduction in LVM in asymptomatic patients with moderate-severe AS compared with placebo, with trends towards improvements in myocardial physiology and slower progression of valvular stenosis. A larger clinical outcome trial to confirm these findings and explore their clinical relevance is required.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.