Association of Long-term Use of Antihypertensive Medications With Late Outcomes Among Patients With Aortic Dissection

Chen, Shaowei; Chan, Yi‐Hsin; Lin, Chiao-Yun; Wu, Victor Chien‐Chia; Cheng, Yu‐Ting; Chen, Dong‐Yi; Chang, Shang‐Hung; Hung, Kuo‐Chun; Chu, Pao‐Hsien; Chou, An‐Hsun

doi:10.1001/jamanetworkopen.2021.0469

Cited by 23 publications

(16 citation statements)

References 28 publications

(58 reference statements)

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“…The reasons for the lack of association between BP and mortality in the HypHist group were not clear in our analysis. However, because most patients with HypHist referred the use of antihypertensive medications, and antihypertensive medications were reported to influence mortality in patients with AD (4,13,14), it is possible that these pharmacological agents influenced the ability of BP at presentation to predict adverse prognosis. Indeed, we found that patients with HypHist using antihypertensive medications had lower 1-year mortality in the SBP range of 140-200 mmHg compared with those not using antihypertensive medications, strengthening the notion that previous use of antihypertensive medications may influence the impact of BP at presentation on prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, it is unknown whether the impact of BP at presentation on prognosis is influenced by a previous diagnosis of hypertension. In this regard, the use of antihypertensive medications is reported to influence the prognosis in patients with AD (4,13,14) and therefore could constitute a potential confounding factor when assessing the relationship between BP at presentation and mortality. In addition, whether BP at presentation could also be a marker of alternative organ damage in patients with AD remains to be established.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection

Oliveira

Rocha

Soares

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThis study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction.MethodsWe investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers.ResultsPatients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008).ConclusionCombined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection

Oliveira

Rocha

Soares

et al. 2022

Front. Cardiovasc. Med.

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“… 9 19 A recent Taiwanese register study demonstrated lower risk of hospital readmission and all-cause mortality in acute AD patients receiving a beta blocker, ACE inhibitor or ARB after discharge from the primary hospitalisation. 20 One potential weakness of the demonstrated favourable effect of beta blockers in surgically manged patients is that the study design does not allow further analysis of the mechanisms. Moreover, roughly 1 in 10 patients of both surgically and medically managed patients, respectively, did not receive beta blockers, but the reason for that decision is unknown.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological treatment in patients with aortic dissection

et al. 2022

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ObjectivesTo describe medical management in aortic dissection (AD) and to analyse the possible associations between antihypertensive, antithrombotic, anticoagulant and statin agents, respectively, and long-term survival.MethodsFrom Swedish medical registers, all patients diagnosed with AD in 2006–2015 were identified. Filled prescriptions prior to admission and within 1 year from discharge in patients discharged and alive at 30 days were registered. Associations between pharmacological treatment and long-term survival were analysed using Cox proportional hazards models.ResultsOf 3951 patients hospitalised with acute AD, 3046 (77%) were discharged and alive at 30 days. In hospitalised patients, mean age was 66 years (SD 13), and 36% (n=1098) were women. Within 1 year from discharge, 96% (n=2939) had at least one antihypertensive drug. Beta blocker was the most commonly used drug type (90%, n=2741). Statin treatment (47%, n=1418) was associated with higher long-term survival; HR 0.74 (95% CI 0.63 to 0.87, p<0.001). The positive association between statins and long-term survival remained, in subgroup analysis, in medically managed patients (HR 0.72 (95% CI 0.60 to 0.86, p<0.001)), but not in patients undergoing surgical repair (HR 0.82 (95% CI 0.58 to 1.14, p=0.230)). Beta blockers were associated with favourable long-term survival in surgically managed patients (HR 0.58 (95% CI 0.35 to 0.97, p=0.038)) but not in medically managed patients (HR 0.93 (95% CI 0.72 to 1.12, p=0.057)). Neither antiplatelet therapy nor anticoagulants were associated with long-term survival.ConclusionsStatin treatment was associated with favourable long-term outcome in medically managed AD patients, whereas treatment with beta blocker was associated with higher survival only in surgically managed AD patients. Statin use as well as optimal antihypertensive therapy in the chronic stage of the disease need to be further analysed, preferably in randomised controlled trials.

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“…Furthermore, the risk of all-cause hospital readmission was lower for the patients that received ACE inhibitors/ARBs (HR, 0.92; 95% CI, 0.84–0.997) and beta-blockers (HR, 0.87; 95% CI, 0.81–0.94) compared to the patients that received the other drug classes. Moreover, there were no statistically significant differences in other endpoints including death due to aortic aneurysm/dissection, major adverse cardiac and cerebrovascular events, and new-onset dialysis, between the two medication groups [ 24 ]. This study’s findings suggest that ACE inhibitors and ARBs could be used instead of beta-blockers to treat patients with chronic aortic dissection.…”

Section: Medical Treatmentmentioning

confidence: 99%

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Papakonstantinou

Benia

Polyzos

et al. 2022

Life

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Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.

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Association of Long-term Use of Antihypertensive Medications With Late Outcomes Among Patients With Aortic Dissection

Cited by 23 publications

References 28 publications

Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection

Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection

Pharmacological treatment in patients with aortic dissection

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

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