Efficacy of losartan vs. atenolol for the prevention of aortic dilation in Marfan syndrome: a randomized clinical trial

Abstract

Among patients with MFS, the use of losartan compared with atenolol did not result in significant differences in the progression of aortic root and ascending aorta diameters over 3 years of follow-up.

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

“…68,69 In patients with Marfan syndrome, beta-blockers and/or losartan may slow aortic root dilatation and reduce the risk of aortic complications and should be considered before and after surgery. [70][71][72] By analogy, while there are no studies that provide evidence, it is common clinical practice to advise beta-blocker or losartan therapy in patients with bicuspid aortic valve if the aortic root and/or ascending aorta is dilated.…”

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…83 Recent data have shown that angiotensin II type 1 receptor blockers have similar positive effects to atenolol in terms of growth reduction of the aortic root in children and young adults with MFS. 81,82 Other alternative therapies include sodium nitroprusside, A1-adrenergic, and non-selective b blockers. 84 Pain relief is also an important component of optimal medical therapy, as persisting pain may indicate progression of the dissection or impending rupture, requiring additional therapy.…”

“…A significant decrease in the degree of aortic root dilatation, relative to body surface area, was observed with both treatments. 81,82 It is now essential to await results of ongoing large, collaborative, randomized controlled trials 276 with clinical end points to assess the novel medical treatments in MFS.…”

The 2017 ESC/EACTS guidelines on the management of valvular heart disease

“…68,69 In patients with Marfan syndrome, beta-blockers and/or losartan may slow aortic root dilatation and reduce the risk of aortic complications and should be considered before and after surgery. [70][71][72] By analogy, while there are no studies that provide evidence, it is common clinical practice to advise beta-blocker or losartan therapy in patients with bicuspid aortic valve if the aortic root and/or ascending aorta is dilated. Women with Marfan syndrome and an aortic diameter >45 mm are strongly discouraged from becoming pregnant without prior repair because of the high risk of dissection.…”