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Comparative Study
. 2021 Mar 1;4(3):e210469.
doi: 10.1001/jamanetworkopen.2021.0469.

Association of Long-term Use of Antihypertensive Medications With Late Outcomes Among Patients With Aortic Dissection

Shao-Wei Chen  1   2 , Yi-Hsin Chan  3 , Chia-Pin Lin  3 , Victor Chien-Chia Wu  3 , Yu-Ting Cheng  3 , Dong-Yi Chen  3 , Shang-Hung Chang  2   3 , Kuo-Chun Hung  3 , Pao-Hsien Chu  3 , An-Hsun Chou  4
Affiliations
Comparative Study

Association of Long-term Use of Antihypertensive Medications With Late Outcomes Among Patients With Aortic Dissection

Shao-Wei Chen et al. JAMA Netw Open. .

Abstract

Importance: The associations between long-term treatment of aortic dissection with various medications and late patient outcomes are poorly understood.

Objective: To compare late outcomes after long-term use of β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or other antihypertensive medications (controls) among patients treated for aortic dissection.

Design, setting, and participants: This population-based retrospective cohort study using the National Health Insurance Research Database in Taiwan included 6978 adult patients with a first-ever aortic dissection who survived to hospital discharge during the period between January 1, 2001, and December 31, 2013, and who received during the first 90 days after discharge a prescription for an ACEI, ARB, β-blocker, or at least 1 other antihypertensive medication. Data analysis was conducted from July 2019 to June 2020.

Exposure: Long-term use of β-blockers, ACEIs, or ARBs, with use of other antihypertensive medications as a control.

Main outcomes and measures: The primary outcomes of interest were all-cause mortality, death due to aortic aneurism or dissection, later aortic operation, major adverse cardiac and cerebrovascular events, hospital readmission, and new-onset dialysis.

Results: Of 6978 total participants, 3492 received a β-blocker, 1729 received an ACEI or ARB, and 1757 received another antihypertension drug. Compared with patients in the other 2 groups, those in the β-blocker group were younger (mean [SD] age, 62.1 [13.9] years vs 68.7 [13.5] years for ACEIs or ARBs and 69.9 [13.8] years for controls) and comprised more male patients (2520 [72.2%] vs 1161 [67.1%] for ACEIs or ARBs and 1224 [69.7%] for controls). The prevalence of medicated hypertension was highest in the ACEI or ARB group (1039 patients [60.1%]), followed by the control group (896 patients [51.0%]), and was lowest in the β-blocker group (1577 patients [45.2%]). Patients who underwent surgery for type A aortic dissection were more likely to be prescribed β-blockers (1134 patients [32.5%]) than an ACEI or ARB (309 patients [17.9%]) or another antihypertension medication (376 patients [21.4%]). After adjusting for multiple propensity scores, there were no significant differences in any of the clinical characteristics among the 3 groups. No differences in the risks for all outcomes were observed between the ACEI or ARB and β-blocker groups. The risk of all-cause hospital readmission was significantly lower in the ACEI or ARB group (subdistribution hazard ratio [HR], 0.92; 95% CI, 0.84-0.997) and β-blocker group (subdistribution HR, 0.87; 95% CI, 0.81-0.94) than in the control group. Moreover, the risk of all-cause mortality was lower in the ACEI or ARB group (HR, 0.79; 95% CI, 0.71-0.89) and the β-blocker group (HR, 0.82; 95% CI, 0.73-0.91) than in the control group. In addition, the risk of all-cause mortality was lower in the ARB group than in the ACEI group (HR, 0.85; 95% CI, 0.76-0.95).

Conclusions and relevance: The use of β-blockers, ACEIs, or ARBs was associated with benefits in the long-term treatment of aortic dissection.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Patient Selection Flowchart
ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.
Figure 2.
Figure 2.. Direct-Adjusted (Estimated) Survival of All-Cause Mortality (A) and Direct-Adjusted (Estimated) Cumulative Incidence Function of Death Due to Aortic Dissection or Aneurysm (B), Major Cardiac and Cerebrovascular Events (MACCEs) (C), and All-Cause Readmission Among Patients With Other Antihypertensive Agents (Control) (D)
ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, β-blocker; HR, hazard ratio; and SHR, subdistribution hazard ratio.
Figure 3.
Figure 3.. Kaplan-Meier Survival Curve of All-Cause Mortality (A) and Unadjusted Cumulative Incidence Function of Aortic Death (B) Among Patients Receiving an Angiotensin Receptor Blocker (ARB) vs Angiotensin-Converting Enzyme Inhibitor (ACEI) in the Inverse Probability of Treatment Weighting–Adjusted Cohort
See this image and copyright information in PMC

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