Are antihypertensive drugs associated with abdominal aortic aneurysms?

Abstract

Objective: The aim of this study was to investigate the association between anti-hypertensive drugs, the risk of developing an abdominal aortic aneurysm (AAA), aortic wall stiffness, collagen turnover, and change in aortic diameter. STUDY DESIGN, SETTINGS AND METHODS: Data on present medication, smoking status, and medical history of participants in two population-based aneurysm screening programs in the United Kingdom were collected by use of questionnaire. Aortic elasticity was measured by M-mode ultrasound scanning. A serum radioimmunoassay of the amino-terminal propeptide of type III procollagen was used to assess collagen turnover in one of the patient series.

Results: Data from 438 cases with an AAA >29 mm and 5373 controls were analyzed. Calcium-channel blockers were independently associated with AAA. The odds ratio of having an AAA was 2.6 (95% confidence interval [CI], 1.5-4.2) after adjusting for all relevant confounders. Other antihypertensive drugs showed no increased risk. No significant differences in growth rates were found in cases exposed to any of the main antihypertensive drugs. An increased collagen turnover was found in subjects receiving angiotensin-converting enzyme (ACE) inhibitors: 4.26 mg/L (95% CI, 3.73-4.79) compared with 3.62 mg/L (95% CI, 3.49-3.76) for subjects not receiving ACE inhibitors. No differences in type III collagen turnover was found with use of any other antihypertensive drug. The mean aortic wall stiffness was greater for all subjects exposed to calcium-channel blockers, whether with AAA or not: 25.1 arbitrary units (95% CI, 20.0-30.2) vs 19.3 (95% CI, 18.1-20.4)(P =.002). By contrast, the mean stiffness for cases receiving ACE inhibitors was smaller than for those not receiving ACE inhibitors: 19.0 (95% CI, 13.9-24.0) vs 25.2 (95% CI, 23.0-27.4).

Conclusions: Calcium-channel blockers were an independent risk factor for the presence of an AAA and were associated with an increased arterial aortic wall stiffness. ACE inhibitors were associated with decreased stiffness and greater collagen turnover. No significant effects on the growth rate of small aneurysms were detected.