Use of angiotensin converting enzyme inhibitors is associated with increased growth rate of abdominal aortic aneurysms
Use of angiotensin converting enzyme inhibitors is associated with increased growth rate of abdominal aortic aneurysms
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DOI：
10.1016/j.jvs.2010.02.264
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发表时间：
2010-07-01
影响因子：
4.3
通讯作者：
Powell, Janet T.
中科院分区：
文献类型：
--
作者：
Sweeting, Michael J.;Thompson, Simon G.;Powell, Janet T.
目的：评价血管紧张素转换酶(ACE)抑制剂或其他抗高血压药物是否能抑制或提高肾下腹主动脉瘤的生长速度。方法：对1991年至1995年在93家医院参加英国小动脉瘤试验或相关研究的1701名患者进行前瞻性队列研究，这些患者至少有两次超声测量动脉瘤直径和基线药物处方数据。超声测量腹主动脉瘤的前后平面直径。结果：169名服用血管紧张素转换酶抑制剂的患者的平均动脉瘤增长率为3.33 mm/年，而其余1532名患者的平均增长率为2.77 mm/年，P=0.009。这一发现的重要性在对已知的混杂因素进行调整后没有改变。未发现任何抗高血压药物的处方和其他特定类别的抗高血压药物与动脉瘤增长率有关。结论：这些结果表明服用ACE抑制剂的患者动脉瘤生长更快，这与加拿大大型数据库中服用ACE抑制剂的动脉瘤患者较不容易出现动脉瘤破裂的观察结果相矛盾。迫切需要一项随机试验来评估血管紧张素转换酶抑制剂对动脉瘤大小低于手术干预阈值的患者是有益还是有害。(《花瓶外科杂志》2010；52：1-4。)
Objectives: To evaluate whether either angiotensin converting enzyme (ACE) inhibitors or other classes of antihypertensive drug attenuate or increase growth rates of small infrarenal abdominal aortic aneurysms.Methods: Prospective cohort study of 1701 patients enrolled in the UK Small Aneurysm Trial or associated study at 93 hospitals between 1991 and 1995 and who had at least two ultrasound measurements of aneurysm diameter and baseline drug prescription data recorded. Abdominal aortic aneurysm diameter was measured in the anterior-posterior plane using ultrasound. The mean growth rate was estimated through a mixed-effects linear growth model.Results: Mean aneurysm growth rate in 169 patients taking ACE inhibitors at baseline was 3.33 mm/y vs 2.77 mm/y in the remaining 1532 patients, P = .009. The significance of this finding did not alter after adjustment for known confounders. The prescription of any antihypertensive agent and other specific classes of antihypertensive drugs were not found to be associated with aneurysm growth rate.Conclusion: These results show that patients taking ACE inhibitors have faster aneurysm growth and are in conflict with the observation from a large Canadian data-base that aneurysm patients taking ACE inhibitors are less likely to present with aneurysm rupture. There is an urgent need for a randomized trial to assess whether ACE inhibitors are beneficial or harmful to patients with aneurysms below the threshold size for surgical intervention. (J Vase Surg 2010;52:1-4.)