Angiotensin receptor blockers (ARBs) reduced the rate of enlargement of the aortic root by about one half in patients with Marfan syndrome, including among those already taking a beta-blocker, according to findings from a large-scale meta-analysis presented during ESC Congress 2022 in Barcelona, and simultaneously published in The Lancet.

Alex Pitcher, MD, et al., analyzed seven randomized trials comparing an ARB vs. control or an ARB vs. beta-blocker in patients with Marfan syndrome with no prior aortic surgery. Individual patient data from 1,442 patients were included and the primary endpoint was the annual rate of change of body surface area-adjusted aortic root dimension Z score, measured at the sinuses of Valsalva.

Overall results found ARBs successfully reduced the rate of enlargement of the aortic root, with no evidence that the effect size depended on use of beta-blockers. The greatest benefit was seen among those with a pathogenic FBN1 variant. In four trials comparing ARB with control, allocation to ARB approximately halved the annual rate of change in the aortic root Z score over a median follow-up period of three years. Three other trials comparing ARBs with beta-blockers found similar rates of annual change in the aortic root Z score across both the ARB and beta-blocker groups over the course of three years.

"Our findings therefore suggest that, if tolerated, the combination of a beta-blocker and ARB would reduce the rate of enlargement of the aortic root by at least one half, and potentially by much more than this which, if maintained over a sustained period, would be expected to delay the need for surgery substantially," researchers said.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease

Keywords: ESC Congress, ESC22, ACC International, Angiotensin Receptor Antagonists, Marfan Syndrome, Angiotensin-Converting Enzyme Inhibitors

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