title: Efficacy of losartan vs. atenolol for the prevention of aortic dilation in Marfan syndrome: a randomized clinical trial.
abstract: OBJECTIVE
  To determine the efficacy of losartan vs. atenolol in aortic dilation progression in Marfan syndrome (MFS) patients.
  
  
  RESULTS
  A phase IIIb, randomized, parallel, double-blind study was conducted in 140 MFS patients, age range: 5-60 years, with maximum aortic diameter <45 mm who received losartan (n = 70) or atenolol (n = 70). Doses were raised to a maximum of 1.4 mg/kg/day or 100 mg/day. The primary end-point was the change in aortic root and ascending aorta maximum diameter indexed by body surface area on magnetic resonance imaging after 36 months of treatment. No serious drug-related adverse effects were observed. Five patients presented aortic events during a follow-up (one in the losartan and four in the atenolol groups, P = 0.366). After 3 years of follow-up, aortic root diameter increased significantly in both groups: 1.1 mm (95% CI 0.6-1.6) in the losartan and 1.4 mm (95% CI 0.9-1.9) in the atenolol group, with aortic dilatation progression being similar in both groups: absolute difference between losartan and atenolol -0.3 mm (95% CI -1.1 to 0.4, P = 0.382) and indexed by BSA -0.5 mm/m2 (95% CI -1.2 to 0.1, P = 0.092). Similarly, no significant differences were found in indexed ascending aorta diameter changes between the losartan and atenolol groups: -0.3 mm/m2 (95% CI -0.8 to 0.3, P = 0.326).
  
  
  CONCLUSIONS
  Among patients with MFS, the use of losartan compared with atenolol did not result in significant differences in the progression of aortic root and ascending aorta diameters over 3 years of follow-up.
authors.affiliation: Marfan Unit, University Hospital 12 de Octubre, Madrid, Spain Marfan Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain apforteza@yahoo.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Forteza
authors.affiliation: Servei de Cardiologia, Unitat de Marfan, Hospital Universitari, Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Marfan Unit, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Violeta
authors.initials: V
authors.lastname: Sánchez
authors.affiliation: Servei de Cardiologia, Unitat de Marfan, Hospital Universitari, Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Gisela
authors.initials: G
authors.lastname: Teixidó-Turà
authors.affiliation: Marfan Unit, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Paz
authors.initials: P
authors.lastname: Sanz
authors.affiliation: Servei de Cardiologia, Unitat de Marfan, Hospital Universitari, Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Gutiérrez
authors.affiliation: Marfan Unit, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gracia
authors.affiliation: Marfan Unit, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Centeno
authors.affiliation: Servei de Cardiologia, Unitat de Marfan, Hospital Universitari, Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Rodríguez-Palomares
authors.affiliation: Marfan Unit, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Rufilanchas
authors.affiliation: Marfan Unit, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Cortina
authors.affiliation: Servei de Cardiologia, Unitat de Marfan, Hospital Universitari, Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER de epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
authors.affiliation: Servei de Cardiologia, Unitat de Marfan, Hospital Universitari, Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
mesh_terms: D000293:Adolescent; D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001011:Aorta; D001014:Aortic Aneurysm / Q000517:prevention & control*; D001262:Atenolol / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D018810:Magnetic Resonance Angiography; D019028:Magnetic Resonance Imaging, Cine; D008382:Marfan Syndrome / Q000150:complications*; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001262:Atenolol; D019808:Losartan
keywords: Aorta; Losartan; Magnetic resonance imaging; Marfan