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Effect of Telmisartan on the Peak Wall Stress and Peak Wall Rupture Index of Small Abdominal Aortic Aneurysms: An Exploratory Analysis of the TEDY Trial

Published:August 06, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.07.042

      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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      Linked 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
        • Preview
          In 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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