Key result
RAS agents or β-blocker/CCB combinations linked to ~42% fewer adverse outcomes in non-operated aortic dissection.
Why the study?
Aortic dissection is a life-threatening disease, but the effectiveness of different strategies of antihypertensive therapies in non-operated patients remains unclear.
Do specific classes or combinations of antihypertensive drugs reduce the composite outcome of AD-related re-hospitalization, surgery referral, and all-cause death in non-operated aortic dissection patients?
Cohort (n=3,932)
Do specific classes or combinations of antihypertensive drugs reduce the composite outcome of AD-related re-hospitalization, surgery referral, and all-cause death in non-operated aortic dissection patients?
In non-operated aortic dissection patients, specific antihypertensive regimens including RAS agents alone or combinations of β-blockers, CCBs, and RAS agents significantly reduce the risk of AD-related complications and death compared to other agents.
Supports RAS agents or β-blocker+CCB combinations in non-operated aortic dissection; hypothesis-generating and requires RCT confirmation.
Introduction: Aortic dissection (AD) is a life-threatening disease. However, the effectiveness of different strategies of antihypertensive therapies in non-operated AD patients is still unclear. Materials and methods: Patients were classified into five groups (groups 0–4) based on the number of classes of antihypertensive drugs, including β-blockers, renin-angiotensin system (RAS) agents (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and the renin-inhibitors), calcium channel blockers (CCBs), and other antihypertensive drugs, were prescribed within 90 days after discharge. The primary endpoint was a composite outcome of re-hospitalization associated with AD, referral for aortic surgery, and all-cause death. Results: A total of 3932 non-operated AD patients were included in our study. The most prescribed antihypertensive drugs were CCBs, followed by β-blockers and ARBs. Within group 1, compared to other antihypertensive drugs, patients using RAS agents (aHR, 0.58; p = 0.005) had a significantly lower risk of occurrence of the outcome. Within group 2, the risk of composite outcomes was lower in patients using β-blockers + CCBs (aHR, 0.60; p = 0.004) or CCBs + RAS agents (aHR, 0.60; p = 0.006) than in those using RAS agents + others. Conclusion: For non-operated AD patients, RAS agents, β-blockers, or CCBs should be given in a different strategy of combinations to reduce the hazard of AD-related complications compared to other agents.
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Huang et al. (2023) conducted a cohort in Non-operated aortic dissection (n=3,932). Antihypertensive drugs (RAS agents, β-blockers, CCBs) vs. Other antihypertensive drugs or different combinations was evaluated on Composite outcome of re-hospitalization associated with AD, referral for aortic surgery, and all-cause death (aHR 0.58, p=0.005). In non-operated aortic dissection patients, using RAS agents alone (aHR 0.58; p=0.005) or combinations like β-blockers+CCBs (aHR 0.60; p=0.004) significantly reduced the risk of adverse outcomes.
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