Losartan added to β-blockade therapy for aortic root dilation in marfan syndrome: A randomized, open-label pilot study

Hsin Hui Chiu, Mei Hwan Wu, Jou Kou Wang, Chun Wei Lu, Shuenn Nan Chiu, Chun An Chen, Ming Tai Lin, Fu Chang Hu

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Abstract

Objective: To assess the tolerability and efficacy of the investigational use of the angiotensin II receptor blocker losartan added to β-blockade (BB) to prevent progressive aortic root dilation in patients with Marfan syndrome (MFS). Patients and Methods: Between May 1, 2007, and September 31, 2011, 28 patients with MFS (11 males [39%]; mean ± SD age, 13.1±6.3 years) with recognized aortic root dilation (z score >2.0) and receiving BB (atenolol or propranolol) treatment were enrolled. They were randomized to receive BB (BB: 13 patients) or β-blockade and losartan (BB-L: 15 patients) for 35 months. Results: In the BB-L group, aortic root dilation was reduced with treatment, and the annual dilation rate of the aortic root was significantly lower than that of the BB group (0.10mm/yr vs 0.89mm/yr; P=.02). The absolute aortic diameters at the sinus of Valsalva, annulus, and sinotubular junction showed similar trends, with a reduced rate of dilation in the BB-L group (P=.02, P=.03, and P=.03, respectively). Five patients (33%) treated with BB-L were noted to have a reduced aortic root diameter. However, the differences between the groups regarding changes in aortic stiffness and cross-sectional compliance were not statistically significant. Conclusion: This randomized, open-label, active controlled trial mostly based on a pediatric population demonstrated for the first time that losartan add-on BB therapy is safe and provides more effective protection to slow the progression of aortic root dilation than does BB treatment alone in patients with MFS.

Original languageEnglish
Pages (from-to)271-276
Number of pages6
JournalMayo Clinic Proceedings
Volume88
Issue number3
DOIs
Publication statusPublished - Mar 2013
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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    Chiu, H. H., Wu, M. H., Wang, J. K., Lu, C. W., Chiu, S. N., Chen, C. A., Lin, M. T., & Hu, F. C. (2013). Losartan added to β-blockade therapy for aortic root dilation in marfan syndrome: A randomized, open-label pilot study. Mayo Clinic Proceedings, 88(3), 271-276. https://doi.org/10.1016/j.mayocp.2012.11.005