Beta-blockers have long been recommended to prevent aortic dissection associated with Marfansyndrome, but a new analysis also supports a benefit from ARBs and further suggests that the two agents exert independent effects. ESCCongress
Beta-blockers have long been recommended to prevent aortic dissection associated with Marfan syndrome despite limited evidence, but a new analysis also supports a benefit from angiotensin receptors blockers and further suggests that beta-blockers and ARBs exert independent effects.
"We think that medical treatments can delay surgery and dissection substantially if given for a number of years," he added. In the first set of trials, the analysis showed a significantly slower annualized aortic root growth rate for those treated with ARBs relative to controls , producing a statistically significant absolute difference in favor of the ARB.In the three trials comparing ARBs to beta-blockers, the annualized growth rate among those taking an ARB was similar to that seen in the previous set of controlled trials. This rate of annualized growth was not significantly different from the 0.
Of patients genotyped in the ARB studies, more than 80% had the FBN1 pathogenic variant of Marfan syndrome. When the data were analyzed by subgroups, including age or blood pressure, there were no differences in treatment effect except for those with the FBN1 mutation in whom the benefit of ARB therapy was greater relative to those without.
As for the mechanism, it is reasonable to speculate the antihypertensive effect of both medications is relevant, but each has plausible independent activities that might contribute to modifying aortic growth, according to Roland R.J. van Kimmenade, MD, PhD, a specialist in aortic diseases and heart failure at Raboud University Medical Center, Nijmegan, the Netherlands.
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