This study aimed to investigate the effects of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on pathological scar formation, following median sternotomy, focusing on the role of the renin-angiotensin system (RAS) in tissue remodelling and wound healing. Designed as a cross-sectional observational study, it included 100 patients who had undergone median sternotomy at least 6 months prior and were receiving continuous antihypertensive treatment. Patients were categorised into three groups based on their medications: ACEIs (n = 33), ARBs (n = 35), and other antihypertensives (n = 32). Scar formation was evaluated using the Patient and Observer Scar Assessment Scale (POSAS v2.0), which assesses both subjective and objective parameters. The study showed that keloid formation was significantly less common in the ACEI (24.2%) and ARB (25.7%) groups compared to the group using other antihypertensives (53.1%, p = 0.021). Both OSAS and PSAS total scores were significantly lower in the ACEI and ARB groups (p = 0.036 and p = 0.042, respectively). Among OSAS subparameters, vascularization (p = 0.005), pigmentation (p = 0.012), thickness (p = 0.010), and surface appearance (p = 0.007) were significantly improved in the ACEI and ARB groups. Among PSAS subparameters, pain (p = 0.003), stiffness (p = 0.021), thickness (p = 0.013), and irregularity (p = 0.025) were significantly lower in these groups compared to the other antihypertensives group. Our findings suggest that ACEIs and ARBs, commonly used for hypertension, may be associated with improved scar quality and a reduced tendency for keloid formation. These medications could represent a promising and cost-effective alternative to traditional scar treatments, particularly in hypertensive patients. However, given the cross-sectional design of our study and the variability in postoperative durations among patients, these findings should be interpreted as exploratory. While associations were observed, causality remains uncertain. Further larger, prospective, randomised controlled studies with standardised evaluation times and detailed information on medications and dosages are needed to better clarify the potential role of ACEIs and ARBs in scar management.
Güney et al. (Wed,) studied this question.