Objective
This study was an unplanned exploratory analysis of a subset of participants from
the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial. It aimed
to assess the efficacy of the angiotensin 1 receptor blocker telmisartan in reducing
abdominal aortic aneurysm (AAA) peak wall stress (PWS) and peak wall rupture index
(PWRI) among individuals with small AAAs.
Methods
Participants with AAAs measuring 35 – 49 mm in maximum diameter were randomised to
receive telmisartan 40 mg or identical placebo in the TEDY trial. Participants who
had computed tomography angiography performed at entry and at least one other time
point during the trial (12 or 24 months) were included in the current study. Orthogonal
AAA diameter, PWS, and PWRI were measured using previously validated methods. The
annual change in PWS and PWRI from baseline was compared between participants allocated
telmisartan or placebo using linear mixed effects models. These models were either
unadjusted or adjusted for risk factors that were different in the groups at entry
(p < .100) or systolic blood pressure (SBP) at one year.
Results
Of the 207 participants recruited to TEDY, 124 were eligible for inclusion in this
study. This study included 65 and 59 participants from the telmisartan and placebo
groups, respectively. The PWS and PWRI were not significantly different in the two
groups at baseline. Participants allocated telmisartan had a slower annual increase
in PWS (-4.19; 95% CI –8.24, –0.14 kPa/year; p = .043) and PWRI (–0.014; 95% CI –0.026, –0.001; p = .032) compared with those allocated placebo after adjusting for risk factors. After
adjustment for SBP at one year, telmisartan did not significantly reduce annual increases
in PWS or PWRI.
Conclusion
The findings of this study suggest that telmisartan limits the rate of increase in
PWS and PWRI of small AAAs by reducing blood pressure.
Keywords
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References
- Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the global burden of disease study 2013.Lancet. 2015; 385: 117-171
- Abdominal aortic aneurysm: Update on pathogenesis and medical treatments.Nat Rev Cardiol. 2019; 16: 225-242
- Lack of an effective drug therapy for abdominal aortic aneurysm.J Int Med. 2020; 288: 6-22
- Effect of blood pressure lowering drugs and antibiotics on abdominal aortic aneurysm growth: A systematic review and meta-analysis.Heart. 2021; 107: 1465-1471
- Challenges and opportunities in limiting abdominal aortic aneurysm growth.J Vasc Surg. 2017; 65: 225-233
- Comparison of surveillance versus aortic endografting for small aneurysm repair (caesar): Results from a randomised trial.Eur J Vasc Endovasc Surg. 2011; 41: 13-25
- Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK small aneurysm trial participants.Lancet. 1998; 352: 1649-1655
- Systematic review and meta-analysis of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms.J Am Heart Assoc. 2021; 10e019772
- Increased peak wall stress, but not maximum diameter, is associated with symptomatic abdominal aortic aneurysm.Eur J Vasc Endovasc Surg. 2017; 54: 706-711
- (peak) wall stress as an indicator of abdominal aortic aneurysm severity.IEEE Western New York Image and Signal Processing Workshop (WNYISPW). 2018; 1–5 (2018)
- A novel strategy to translate the biomechanical rupture risk of abdominal aortic aneurysms to their equivalent diameter risk: Method and retrospective validation.Eur J Vasc Endovasc Surg. 2014; 47: 288-295
- Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms.Br J Surg. 2021; 108: 652-658
- Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms.Br J Surg. 2012; 99: 655-665
- Efficacy of telmisartan to slow growth of small abdominal aortic aneurysms: A randomized clinical trial.JAMA Cardiol. 2020; 5: 1374-1381
- At1 receptor signaling pathways in the cardiovascular system.Pharmacol Res. 2017; 125: 4-13
- Telmisartan in the management of abdominal aortic aneurysm (tedy): The study protocol for a randomized controlled trial.Trials. 2015; 16: 1-10
- Thrombus volume is similar in patients with ruptured and intact abdominal aortic aneurysms.J Vasc Surg. 2014; 59: 315-320
- Measurement and determinants of infrarenal aortic thrombus volume.Eur Radiol. 2008; 18: 1987-1994
- Comparison of volume and diameter measurement in assessing small abdominal aortic aneurysm expansion examined using computed tomographic angiography.Eur J Radiol. 2011; 79: 42-47
- The effects of aneurysm on the biaxial mechanical behavior of human abdominal aorta.J Biomechanics. 2006; 39: 1324-1334
- Variance inflation factor: As a condition for the inclusion of suppressor variable (s) in regression analysis.Open J Stat. 2015; 5: 754
- Aortic wall stress in hypertension and ascending thoracic aortic aneurysms: Implications for antihypertensive therapy.High Blood Press Cardiovasc Prev. 2013; 20: 265-271
- The impact of angiotensin receptor blockers on arterial stiffness: A meta-analysis.Hypertens Res. 2015; 38: 613-620
- Importance of material model in wall stress prediction in abdominal aortic aneurysms.Med Eng Phys. 2013; 35: 1282-1289
- Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms.Br J Surg. 2014; 101: 1350-1357
- Prediction of rupture risk in abdominal aortic aneurysm during observation: Wall stress versus diameter.J Vasc Surg. 2003; 37: 724-732
- Cohort study examining the association between blood pressure and cardiovascular events in patients with peripheral artery disease.J Am Heart Assoc. 2019; 8e010748
- Editor's choice–European Society For Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.Eur J Vasc Endovasc Surg. 2019; 57: 8-93
- Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis.Lancet. 2016; 387: 957-967
- Prescription of pharmacotherapy and the incidence of stroke in patients with symptoms of peripheral artery disease.Stroke. 2018; 49: 2953-2960
- Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.Eur J Vasc Endovasc Surg. 2020; 60: 365-373
Article info
Publication history
Published online: August 06, 2022
Accepted:
July 22,
2022
Received:
July 9,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of European Society for Vascular Surgery. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Are There Additional Benefits of Blood Pressure Control in Patients with Abdominal Aortic Aneurysm Besides Cardiovascular Risk Reduction?European Journal of Vascular and Endovascular SurgeryVol. 64Issue 4
- PreviewIn this issue,1 Singh et al. report on the effects of the angiotensin 1 receptor blocker telmisartan in reducing abdominal aortic aneurysm (AAA) peak wall stress (PWS) and the peak wall rupture index (PWRI) in a subgroup of patients with small AAAs from the Telmisartan in the Management of Abdominal Aortic Aneurysm (TEDY) trial. In this randomised study, no effects upon AAA growth with telmisartan were demonstrated in spite of mechanisms linked to vascular protection associated with telmisartan, for example improvement of arterial remodelling, anti-oxidation, and antifibrotic effects in an animal model.
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