Mortality rates lowered in aortic dissection with beta-blockers and RAAS inhibitors; JAMA

The associations between long-term treatment of aortic dissection with various medications and late patient outcomes are poorly understood. Emerging evidence has suggested that angiotensin II levels in the renin-angiotensin system are markedly increased in human AA through the ACE-dependent and the chymase-dependent pathways. Limited experimental and clinical studies have indicated that ACEIs and ARBs inhibit growth of AAs.

To bridge the gap, researchers undertook the recent study to compare late outcomes after long-term use of β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or other antihypertensive medications (controls) among patients treated for aortic dissection.

The study design consisted of a population-based retrospective cohort study using the National Health Insurance Research Database in Taiwan included 6978 adult patients with a first-ever aortic dissection who survived to hospital discharge during the period between January 1, 2001, and December 31, 2013, and who received during the first 90 days after discharge a prescription for an ACEI, ARB, β-blocker, or at least 1 other antihypertensive medication. Data analysis was conducted from July 2019 to June 2020. The primary outcomes of interest were all-cause mortality, death due to aortic aneurism or dissection, later aortic operation, major adverse cardiac and cerebrovascular events, hospital readmission, and new-onset dialysis.

Data analysis revealed the following facts.

• Of 6978 total participants, 3492 received a β-blocker, 1729 received an ACEI or ARB, and 1757 received another antihypertension drug.
• Compared with patients in the other 2 groups, those in the β-blocker group were younger (mean [SD] age, 62.1 [13.9] years vs 68.7 [13.5] years for ACEIs or ARBs and 69.9 [13.8] years for controls) and comprised more male patients (2520 [72.2%] vs 1161 [67.1%] for ACEIs or ARBs and 1224 [69.7%] for controls).
• The prevalence of medicated hypertension was highest in the ACEI or ARB group (1039 patients [60.1%]), followed by the control group (896 patients [51.0%]), and was lowest in the β-blocker group (1577 patients [45.2%]).
• Patients who underwent surgery for type A aortic dissection were more likely to be prescribed β-blockers (1134 patients [32.5%]) than an ACEI or ARB (309 patients [17.9%]) or another antihypertension medication (376 patients [21.4%]). After adjusting for multiple propensity scores, there were no significant differences in any of the clinical characteristics among the 3 groups.
• No differences in the risks for all outcomes were observed between the ACEI or ARB and β-blocker groups.
• The risk of all-cause hospital readmission was significantly lower in the ACEI or ARB group (subdistribution hazard ratio [HR], 0.92; 95% CI, 0.84-0.997) and β-blocker group (subdistribution HR, 0.87; 95% CI, 0.81-0.94) than in the control group.
• Moreover, the risk of all-cause mortality was lower in the ACEI or ARB group (HR, 0.79; 95% CI, 0.71-0.89) and the β-blocker group (HR, 0.82; 95% CI, 0.73-0.91) than in the control group.
• In addition, the risk of all-cause mortality was lower in the ARB group than in the ACEI group (HR, 0.85; 95% CI, 0.76-0.95).

For the full article follow the link: Chen SW, Chan YH, Lin CP, Wu VC, Cheng YT, Chen DY, Chang SH, Hung KC, Chu PH, Chou AH. Association of Long-term Use of Antihypertensive Medications With Late Outcomes Among Patients With Aortic Dissection. JAMA Netw Open. 2021;4(3):e210469. doi: 10.1001/jamanetworkopen.2021.0469. PMID: 33656527

Primary source: JAMA Open Network