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
References