title: Chronic beta-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection.
abstract: OBJECTIVE
  To compare the medical treatment of chronic type B aortic dissection with beta-blockers versus other antihypertensive treatments in terms of their requirement for surgical intervention and treatment costs.
  
  
  METHODS
  Case records of the 130 patients treated for aortic dissection type B in this unit between 1988 and 1997 were reviewed. Seventy-eight of 130 patients with chronic dissection have received isolated medical treatment. Seventy-one of 78 patients were discharged alive. Fifty-one of 71 received beta-blocker treatment, 20/71 were treated with other antihypertensive drugs.
  
  
  RESULTS
  Surgery for aortic dissection became necessary in 20/71 patients (28%) during follow-up (mean, 4.2 years): 10/51 in the beta-blocker group and 9/20 in the other antihypertensive drug group. The freedom from subsequent aortic operation was 80 and 47%, respectively (P=0.001). Indications for emergency surgery were increased aortic diameter (79%), symptomatic aortic aneurysm (11%), and renal artery hypoperfusion (5%). The median hospitalization time during follow-up (dissection-related) was 2 days for patients who received beta-blockers and 16 days for patients who received other antihypertensive drug treatments (P=0.001). The cost of treatment/patient per year amounted to 644 and 12748 euros, respectively.
  
  
  CONCLUSIONS
  A substantial proportion of patients with chronic type B dissection who receive initial medical management will later need surgery. Long-term treatment with beta-blockers reduces the progression of aortic dilatation, the incidence of subsequent hospital admissions, as well as the incidence of late dissection-related aortic procedures and the cost of treatment. Patients with chronic type B dissection need, in addition to frequent follow-up of aortic diameter, continuous treatment with beta-blocking agents.
authors.affiliation: Division of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland. michele.genoni@triemli.stzh.ch
authors.forename: M
authors.initials: M
authors.lastname: Genoni
authors.forename: M
authors.initials: M
authors.lastname: Paul
authors.forename: R
authors.initials: R
authors.lastname: Jenni
authors.forename: K
authors.initials: K
authors.lastname: Graves
authors.forename: B
authors.initials: B
authors.lastname: Seifert
authors.forename: M
authors.initials: M
authors.lastname: Turina
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000188:drug therapy* / Q000191:economics; D001014:Aortic Aneurysm / Q000188:drug therapy* / Q000191:economics; D002908:Chronic Disease; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D013557:Switzerland
chemical_list: D000319:Adrenergic beta-Antagonists