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Clinical Summary

Irbesartan slows aortic dilatation in Marfan syndrome

Takeaway

  • The angiotensin receptor blocker (ARB) irbesartan slowed progression of aortic dilatation in this randomised, placebo-controlled trial of children and adults with Marfan syndrome.

Why this matters

  • Beta-blockers are a common intervention to try to reduce aortic dilatation progression.
  • Trials of the ARB losartan head-to-head with beta-blockers or control have yielded mixed effects.
  • Irbesartan, these authors say, might have a greater effect because of factors such as improved bioavailability.

Key results

  • Follow-up was 5 years.
  • Participants were a median of 18 (interquartile range, 12-28) years of age.
  • 56% were taking beta-blockers.
  • At baseline, average aortic root diameter was 34.4 mm.
  • With irbesartan, progression was 0.53 mm/year (95% CI, 0.39-0.67).
  • With placebo, progression was 0.74 mm/year (95% CI, 0.60-0.89).
  • Difference in means: −0.22 mm/year (95% CI, −0.41 to −0.02; P=.030).
  • At 3 years, the diameters differed by a mean of −0.67 mm (95% CI, −1.32 to −0.03; P=.041).
  • No significant differences in serious adverse event rates seen, and no deaths occurred during the trial.
  • BP decreased in the irbesartan group but increased with placebo.

Study design

  • Placebo-controlled, double-blind, randomised trial, 22 UK centres, with 104 in the irbesartan group and 88 in placebo.
  • Funding: British Heart Foundation; UK Marfan Trust; others.

Limitations

  • Expected sample size (490) not achieved.

References


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