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  • Mortality rates...

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

Written By : Dr Satabdi Saha |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-03-16T10:00:47+05:30  |  Updated On 16 March 2021 12:46 PM IST
Mortality rates lowered in aortic dissection with beta-blockers and RAAS inhibitors; JAMA

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Aspirin should be favoured over warfarin to prevent blood clotting in children who undergo a surgery that replumbs their hearts, according to a new study.

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jesse orrico

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According to a recent research report, the use of beta-blockers, ACEIs, or ARBs was associated with benefits in the long-term treatment of aortic dissection. The findings have been put forth in JAMA Open Network.

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


JAMA Network Openmortality rateBeta blockersRAAS inhibitorsaortic dissection
Source : JAMA Open Network
Dr Satabdi Saha
Dr Satabdi Saha

    Dr Satabdi Saha (BDS, MDS) is a practicing pediatric dentist with a keen interest in new medical researches and updates. She has completed her BDS from North Bengal Dental College ,Darjeeling. Then she went on to secure an ALL INDIA NEET PG rank and completed her MDS from the first dental college in the country – Dr R. Ahmed Dental College and Hospital. She is currently attached to The Marwari Relief Society Hospital as a consultant along with private practice of 2 years. She has published scientific papers in national and international journals. Her strong passion of sharing knowledge with the medical fraternity has motivated her to be a part of Medical Dialogues.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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