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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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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