Certain BP medications beneficial in aortic dissection
Long-term treatment with beta-blockers, ACE inhibitors or angiotensin receptor blockers was associated with improvements in aortic dissection treatment, according to data published in JAMA Network Open.
“In aortic dissection, long-term medical therapy is usually prescribed to decrease the stress on the aortic wall and prevent aortic expansion or rupture,” Shao-Wei Chen, MD, PhD, from the division of thoracic and cardiovascular surgery in the department of surgery at Chang Gung University and the Center for Big Data Analytics and Statistics at Chang Gung Memorial Hospital in the Linkou Medical Center, Taoyuan City, Taiwan, and colleagues wrote. “However, no randomized clinical trial has compared the effects of long-term treatment with beta-blockers, ACE inhibitors or angiotensin receptor blockers with those of other antihypertensive medications after aortic dissection.”
For the population-based retrospective cohort study, researchers evaluated data on 6,978 adult patients from the National Health Insurance Research Database in Taiwan. Patients had first-ever aortic dissection and were discharged from the hospital from 2001 to 2013. Patients also received a prescription for an ACE inhibitor, angiotensin receptor blocker, beta-blocker or at least one other antihypertensive medication during the first 90 days after hospital discharge.
The primary outcomes were all-cause mortality, death from aortic aneurysm or dissection, later aortic operation, major adverse cardiac and cerebrovascular events, hospital readmission and new-onset dialysis.
In the cohort, 3,492 patients received a beta-blocker, 1,729 patients received an ACE inhibitor or angiotensin receptor blocker and 1,757 patients received different antihypertensive drugs.
Patients who received beta-blockers were younger, with a mean age of 62 years compared with 69 years for those who received ACE inhibitors or angiotensin receptor blockers and 70 years for controls. The beta-blocker group also included more male patients compared with the ACE inhibitor/angiotensin receptor blocker group and the control group (72.2% vs. 67.1% vs. 69.7%, respectively).
The ACE inhibitor/angiotensin receptor blocker group had a higher prevalence of medicated hypertension (60.1%) compared with the control group (51%) and the beta-blocker group (45.2%). Those who underwent type A aortic dissection surgery had a higher likelihood of being prescribed beta-blockers, with 32.5% of patients, compared with 17.9% of patients who received ACE inhibitors/angiotensin receptor blockers or 21.4% of patients who received other antihypertensive medications.
The ACE inhibitor or angiotensin receptor blocker groups (HR = 0.92; 95% CI, 0.84-0.99) and the beta-blocker group (HR = 0.87; 95% CI, 0.81-0.94) had significantly lower risks for all-cause hospital readmission compared with the control group.
The ACE inhibitor/angiotensin receptor blocker group (HR = 0.79; 95% CI, 0.71-0.89) and the beta-blocker group (HR = 0.82; 95% CI, 0.73-0.91) also had lower risk for all-cause mortality than the control group.
The angiotensin receptor blocker group demonstrated lower risk for all-cause mortality compared with the ACE inhibitor group (HR = 0.85; 95% CI, 0.76-0.95).
Researchers observed no significant differences in clinical characteristics or risks for all outcomes among all patients.
“These data provide evidence that ACE inhibitor and angiotensin receptor blocker therapies may be alternatives to beta-blocker use for the long-term treatment of aortic dissection,” the researchers wrote.