title: Distinct effects of losartan and atenolol on vascular stiffness in Marfan syndrome.
abstract: We conducted a randomized, double-blind trial of losartan (100 mg QD) versus atenolol (50 mg QD) for 6 months in adults with Marfan syndrome. Carotid-femoral pulse wave velocity (PWV), central augmentation index (AIx), aortic diameter and left ventricular (LV) function were assessed with arterial tonometry and echocardiography. Thirty-four subjects (18 female; median age 35 years, IQR 27, 45) were randomized. Central systolic and diastolic blood pressure decreased comparably with atenolol and losartan (p = 0.64 and 0.31, respectively); heart rate decreased with atenolol (p = 0.02), but not with losartan. PWV decreased in patients treated with atenolol (-1.15 ± 1.68 m/s; p = 0.01), but not in those treated with losartan (-0.22 ± 0.59 m/s; p = 0.15; between-group difference p = 0.04). In contrast, AIx decreased in the losartan group (-9.6 ± 8.6%; p < 0.001) but not in the atenolol group (0.9 ± 6.2%, p = 0.57; between-group difference p < 0.001). There was no significant change in aortic diameters or LV ejection fraction in either treatment group. In adults with Marfan syndrome, 6 months of treatment with atenolol improves PWV, whereas losartan reduces the AIx. By improving vascular stiffness via distinct mechanisms of action, there is physiologic value to considering the use of both medications in individuals with Marfan syndrome.
authors: Brigham and Women's Hospital, Boston, MA, USA Massachusetts General Hospital, Boston, MA, USA Children's Hospital of Boston, Boston, MA, USA Harvard Medical School, Boston, MA, USA abhatt@mgh.harvard.edu.
authors: Ami B
authors: AB
authors: Bhatt
authors: Brigham and Women's Hospital, Boston, MA, USA.
authors: J Stewart
authors: JS
authors: Buck
authors: Brigham and Women's Hospital, Boston, MA, USA.
authors: Jonah P
authors: JP
authors: Zuflacht
authors: Brigham and Women's Hospital, Boston, MA, USA.
authors: Jessica
authors: J
authors: Milian
authors: Brigham and Women's Hospital, Boston, MA, USA.
authors: Samoneh
authors: S
authors: Kadivar
authors: Children's Hospital of Boston, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors: Kimberlee
authors: K
authors: Gauvreau
authors: Brigham and Women's Hospital, Boston, MA, USA Children's Hospital of Boston, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors: Michael N
authors: MN
authors: Singh
authors: Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors: Mark A
authors: MA
authors: Creager
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D001262:Atenolol / Q000009:adverse effects / Q000627:therapeutic use*; D001900:Boston; D004311:Double-Blind Method; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008365:Manometry; D008382:Marfan Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D063177:Pulse Wave Analysis; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D001262:Atenolol; D019808:Losartan
keywords: Marfan syndrome; angiotensin receptor blocker; aortic stiffness; augmentation index; pulse wave velocity; β-receptor blocker