Should we prescribe “vasodilating” beta-blockers in Marfan syndrome to prevent aortic aneurysm and dissection?

Koraćević, Goran; Sakač, Dejan; Pavlović, Milan; Ilić, Dušica P.; Tomasević, M; Kostić, Tomislav

doi:10.2298/vsp1202195k

Cited by 7 publications

(2 citation statements)

References 61 publications

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“…Recent studies suggest benefit of vasodilator beta-blockers to control hypertension in MFS patients. 11 Patients needing additional medications to control blood pressure, especially those with chronic dissections, might be treated with an angiotensin receptor blocker in addition to ␤-blockade. 8 In patients with valve replacements, antibiotic prophylaxis and warfarin bridging should be carried out timeously, as was in this case report.…”

Section: Discussionmentioning

confidence: 99%

Marfan Syndrome: new diagnostic criteria, same anesthesia care? Case report and review

Araújo

Marques

Freitas

et al. 2016

Brazilian Journal of Anesthesiology (English Edition)

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Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia.

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Section: Discussionmentioning

confidence: 99%

Marfan Syndrome: new diagnostic criteria, same anesthesia care? Case report and review

Araújo

Marques

Freitas

et al. 2016

Brazilian Journal of Anesthesiology (English Edition)

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“…This is also the case with the current European Society of Cardiology guidelines for the treatment of arterial hypertension from the year 2013. In these recommendations, from the beta-blocker group, vasodilating beta-blockers and highly selective beta-blockers with a better blood pressure regulation profile, better metabolic effects, and more effective reduction of the cardiovascular risk, stand out [25].…”

Section: Heart Rate and Cardiovascular Mortalitymentioning

confidence: 99%

Fixed combination of bisoprolol and a low-dose hydrochlorothiazide in arterial hypertension

et al. 2018

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Beta-blockers showed better results in lowering elevated blood pressure in the younger age group of patients with higher renin plasma levels. Actual recommendations from the European Society of Cardiology for treatment of arterial hypertension from 2013 insist that heart rate should always be measured along with blood pressure. These recommendations point out the significance of resting heart rate as an independent predictor of cardiovascular morbidity and mortality in patients with arterial hypertension. Beta-blockers have a compelling indication for treatment of arterial hypertension in patients with coexistence of coronary artery disease, especially post myocardial infarction, as well as in patients with systolic heart failure. Bisoprolol, a highly selective beta-blocker with a long half-life and a prolonged antihypertensive effect, has shown consistent blood pressure control over a period of 24 hours. It has been demonstrated in placebo-controlled studies that administration of thiazide diuretics, in addition to lowering blood pressure levels, had also been associated with a reduction of cardiovascular morbidity and mortality rates. It is evident that effectiveness of thiazide diuretics is dose-dependent; however, undesirable effects of drugs are also dose-dependent. Depending on the dose, they aggravate glucose intolerance, increase lipid levels, cause hypokalemia, hyponatremia, and hypomagnesemia, and increase levels of uric acid. Administration of very low doses of a thiazide diuretic is acceptable in combination with other antihypertensive drugs, because it potentiates the action of other drugs without causing undesirable metabolic effects. The effectiveness and safety of the combination of bisoprolol (in various doses) and a thiazide diuretic in a small dose has been proven in clinical trials.

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Beta-blockers for preventing aortic dissection in Marfan's syndrome

Koo

Lawrence

Musini

2014

Cochrane Database of Systematic Reviews

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Should we prescribe “vasodilating” beta-blockers in Marfan syndrome to prevent aortic aneurysm and dissection?

Abstract: nem

Cited by 7 publications

References 61 publications

Marfan Syndrome: new diagnostic criteria, same anesthesia care? Case report and review

Marfan Syndrome: new diagnostic criteria, same anesthesia care? Case report and review

Fixed combination of bisoprolol and a low-dose hydrochlorothiazide in arterial hypertension

Beta-blockers for preventing aortic dissection in Marfan's syndrome

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