title: Long-term renin-angiotensin blocking therapy in hypertensive patients with normal aorta may attenuate the formation of abdominal aortic aneurysms.
abstract: Renin-angiotensin system (RAS) has been implicated in the pathogenesis of abdominal aortic aneurysm (AAA). Angiotensin II type 1 receptor blocker (ARB), when given with angiotensin II prevents AAA formation in mice, but found ineffective in attenuating the progression of preexisting AAA. This study was designed to evaluate the effect of chronic RAS blockers on abdominal aortic diameter in hypertensive patients without known aortic aneurysm. Consecutive hypertensive outpatients (n = 122) were stratified according to antihypertensive therapy they received for 12 months or more, consisting of ARB (n = 45), angiotensin converting enzyme inhibitor (ACE-I; n = 45), or nonARB/nonACE-I (control therapy; n = 32). Abdominal ultrasonography was performed to measure maximal subrenal aortic diameter. Eighty-four patients were reexamined by ultrasonography 8 months later. The correlation between the different antihypertensive therapies and aortic diameter was examined. Aortic diameters were significantly smaller in ARB than in control patients in the baseline and follow-up measurements (P = .004; P = .0004, respectively). Risk factor adjusted covariance analysis showed significant differences between ARB or ACE-I treated groups and controls (P = .006 or P = .046, respectively). Ultrasound that was performed 8 months later showed smaller increases in mean aortic diameters of the ARB and ACE-I groups than in controls. Both ARB and ACE-I therapy attenuated expansion of nonaneurysmal abdominal aorta in humans. These results indicate that RAS blockade given before advancement of aortic medial remodeling may slow down the development of AAA.
authors.affiliation: The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Silverberg
authors.affiliation: The Department of Internal Medicine D and Hypertension Clinic, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Anan
authors.initials: A
authors.lastname: Younis
authors.affiliation: The Goldschleger Eye Research Institute, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: Naphtali
authors.initials: N
authors.lastname: Savion
authors.affiliation: Medistat Ltd. Tel Aviv, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Harari
authors.affiliation: The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Yakubovitch
authors.affiliation: The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Basheer
authors.initials: B
authors.lastname: Sheick Yousif
authors.affiliation: The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Halak
authors.affiliation: The Department of Internal Medicine D and Hypertension Clinic, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
authors.affiliation: The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel; The Gottesdiener Vascular Biology Laboratory, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel. Electronic address: jschneid72@yahoo.com.
authors.forename: Jacob
authors.initials: J
authors.lastname: Schneiderman
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D012084:Renin-Angiotensin System / Q000187:drug effects; D012189:Retrospective Studies; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D066253:Vascular Remodeling / Q000187:drug effects*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin II; leptin; vascular remodeling