Beta-blocker and angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) use is associated with benefits in the long-term treatment of aortic dissection (AD) compared with other antihypertensives, according to results of a population-based retrospective cohort study published in JAMA Network Open.
For this study, data from the Taiwanese National Health Insurance Research Database was analyzed. Mortality among patients hospitalized between 2001 and 2013 (N=6978) for treatment for AD and aortic aneurysms was assessed. Over the study period, use of b-blockers increased from 52% in 2001 to 64% in 2013 (P <.001) as did the use of ARBs (19% to 47%; P <.001). The use of ACEIs, however, decreased from 22% to 5% (P <.001) over time.
Fifty percent of the study cohort were prescribed b-blockers, 25% was prescribed ACEIs, and/or ARBs, and the remainder were receiving other antihypertensives. When stratified by prescribed medications, it was noted that patients differed significantly by age, sex, comorbidities, and rates of surgical intervention. To balance these baseline differences, the investigators performed a propensity matching adjustment, which showed that all-cause mortality, repeated aortic surgery, major adverse cardiovascular events, hospital readmission, and new-onset dialysis did not differ significantly between groups.
Compared with other antihypertensive medications, b-blockers were associated with decreased all-cause mortality (hazard ratio [HR], 0.82; 95% CI, 0.73-0.91; P <.05) and hospital readmission (subdistribution HR, 0.87; 95% CI, 0.81-0.94; P <.05). Likewise, ACEIs or ARBs were associated with decreased all-cause mortality (HR, 0.79; 95% CI, 0.71-0.89; P <.05) and hospital readmission (subdistribution HR, 0.92; 95% CI, 0.84-0.997; P <.05).
Risk for all-cause mortality (HR, 0.68; 95% CI, 0.56-0.83) and death from AD or aortic aneurysm (HR, 0.64; 95% CI, 0.47-0.88) was decreased among patients given ACEIs or ARBs combined with b-blockers. Use of ARBs or ACEIs alone were associated with decreased risk of AD- or aortic aneurysm-associated mortality compared with use of b-blockers alone (HR, 0.67; 95% CI, 0.48-0.94).
A limitation of this study was lack of access to clinical cardiac features, including aortic morphology or imaging findings.
These data indicate that use of b-blockers, ACEIs, and/or ARBs are associated with decreased risk of all-cause mortality, death due to AD or aortic aneurysm, and hospital readmission compared with other antihypertensive medications.
Chen S-W, Chan Y-H, Lin C-P, et al. 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