Telmisartan in the Management of Abdominal Aortic Aneurysm - TEDY

Sep 15, 2020
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Health and Medical Research Council, Bupa Foundation, Townsville University Hospital, Medtronic
Date Published:
08/26/2020
Date Updated:
09/15/2020
Original Posted Date:
09/15/2020
References

Contribution To Literature:

The TEDY trial failed to show that telmisartan was superior to placebo at slowing the growth of abdominal aortic aneurysm.

Description:

The goal of the trial was to evaluate the angiotensin-receptor blocker (ARB) telmisartan compared with placebo among patients with abdominal aortic aneurysm.

Study Design

  • Randomized
  • Parallel
  • Double-blind
  • Placebo

Eligible patients were randomized to telmisartan 40 mg daily (n = 107) versus placebo (n = 103).

  • Total number of enrollees: 210
  • Duration of follow-up: 24 months
  • Mean patient age: 73.5 years
  • Percentage female: 12%

Inclusion criteria:

  • Abdominal aortic aneurysm 3.5-4.9 cm

Exclusion criteria:

  • Previous aortic surgery
  • Currently receiving an angiotensin-converting enzyme inhibitor or ARB
  • Renal or hepatic dysfunction
  • Anticipated abdominal aortic aneurysm repair
  • Active gout diagnosis
  • Renal artery stenosis

Other salient features/characteristics:

  • Mean abdominal aortic aneurysm diameter: 4.3 cm

Principal Findings:

The primary outcome, growth rate of the abdominal aortic aneurysm, was 1.68 mm/year in the telmisartan group compared with 1.78 mm/year in the placebo group (p = 0.66).

Secondary outcomes:

  • Change in systolic blood pressure for telmisartan vs. placebo: 8.9 mm Hg (p < 0.001)
  • Change in diastolic blood pressure for telmisartan vs. placebo: 7.0 mm Hg (p < 0.001)
  • Hypotensive symptoms (i.e., syncope): 26% with telmisartan vs. 13% with placebo (p = 0.02)

Interpretation:

Among patients with abdominal aortic aneurysm, telmisartan failed to slow aneurysm growth. Telmisartan was associated with lower blood pressure and hypotensive symptoms compared with placebo. This study was underpowered since it only recruited 70% of the planned enrollment number. At the present time, the use of an ARB to slow abdominal aortic aneurysm growth is not recommended.

References:

Golledge J, Pinchbeck J, Tomee SM, et al. Efficacy of Telmisartan to Slow Growth of Small Abdominal Aortic Aneurysms. JAMA Cardiol 2020;Aug 26:[Epub ahead of print].

Clinical Topics: Geriatric Cardiology, Noninvasive Imaging, Prevention, Vascular Medicine, Computed Tomography, Nuclear Imaging

Keywords: Angiotensin Receptor Antagonists, Aortic Aneurysm, Abdominal, Blood Pressure, Geriatrics, Hypotension, Secondary Prevention, Syncope, Tomography, X-Ray Computed, Vascular Diseases


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