Certain Antihypertensives Tied to Benefit After Aortic Disse
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The associations between long-term treatment of aortic dissection with various medications and late patient outcomes are poorly understood.

This study aimed to compare late outcomes after long-term use of β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or other antihypertensive medications (controls) among patients treated for aortic dissection.

This population-based retrospective cohort study using the National Health Insurance Research Database in Taiwan included 6978 adult patients with a first-ever aortic dissection who survived to hospital discharge during the period between January 1, 2001, and December 31, 2013, and who received during the first 90 days after discharge a prescription for an ACEI, ARB, β-blocker, or at least 1 other antihypertensive medication. Data analysis was conducted from July 2019 to June 2020.

The primary outcomes of interest were all-cause mortality, death due to aortic aneurism or dissection, later aortic operation, major adverse cardiac and cerebrovascular events, hospital readmission, and new-onset dialysis.

Results:
-- Of 6978 total participants, 3492 received a -blocker, 1729 received an ACEI or ARB, and 1757 received another antihypertension drug.

-- Compared with patients in the other 2 groups, those in the β-blocker group were younger and comprised more male patients.

-- The prevalence of medicated hypertension was highest in the ACEI or ARB group (1039 patients), followed by the control group (896 patients), and was lowest in the β-blocker group (1577 patients).

-- Patients who underwent surgery for type A aortic dissection were more likely to be prescribed β-blockers (1134 patients) than an ACEI or ARB (309 patients) or another antihypertension medication (376 patients).

-- After adjusting for multiple propensity scores, there were no significant differences in any of the clinical characteristics among the 3 groups.

-- No differences in the risks for all outcomes were observed between the ACEI or ARB and β-blocker groups.

-- The risk of all-cause hospital readmission was significantly lower in the ACEI or ARB group and β-blocker group than in the control group.

-- Moreover, the risk of all-cause mortality was lower in the ACEI or ARB group and the β-blocker group than in the control group.

-- In addition, the risk of all-cause mortality was lower in the ARB group than in the ACEI group.

Conclusively, the use of β-blockers, ACEIs, or ARBs was associated with benefits in the long-term treatment of aortic dissection.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776943?resultClick=3
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