title: First-line beta-blockers versus other antihypertensive medications for chronic type B aortic dissection.
abstract: BACKGROUND
  Thoracic aortic dissection (TAD) is a severe and often lethal complication in people with hypertension. Current practice in the treatment of chronic type B aortic dissections is the use of beta-blockers as first-line therapy to decrease aortic wall stress. Other antihypertensive medications, such as calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), have been suggested for the medical therapy of type B TAD.
  
  
  OBJECTIVE
  To assess the effects of first-line beta-blockers compared with other first-line antihypertensive drug classes for treating chronic type B TAD.
  
  
  METHODS
  We searched the Database of Abstracts of Reviews of Effects (DARE) for related reviews. We searched the Hypertension Group Specialised Register (1946 to 26 January 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 1), MEDLINE (1946 to 24 January 2014), MEDLINE In-Process, EMBASE (1974 to 24 January 2014) and ClinicalTrials.gov (to 26 January 2014).
  
  
  METHODS
  We considered randomized controlled trials (RCTs) comparing different antihypertensive medications in the treatment of chronic type B TAD to be eligible for inclusion. Total mortality rate was the primary outcome of this review. Secondary outcomes included total non-fatal adverse events relating to TADs and number of people not requiring surgical treatment.
  
  
  METHODS
  Two review authors (KC, PL) independently reviewed titles and abstracts and decided on studies to include based on the inclusion criteria. We resolved discrepancies between the two review authors by discussion.
  
  
  RESULTS
  After a thorough review of the search results, we identified no studies that met the inclusion criteria.
  
  
  CONCLUSIONS
  We did not find any RCTs that compared first-line beta-blockers with other first-line antihypertensive medications for the treatment of chronic type B TAD. Therefore, there is no RCT evidence to support the current guidelines recommending the use of beta-blockers. RCTs are required to assess the benefits and harms of beta-blockers and other antihypertensive medications as first-line treatment of chronic type B TAD.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Chan
authors.forename: Peggy
authors.initials: P
authors.lastname: Lai
authors.forename: James M
authors.initials: JM
authors.lastname: Wright
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000784:Aortic Dissection / Q000188:drug therapy* / Q000209:etiology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D017545:Aortic Aneurysm, Thoracic / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents