A review of data on hospitalized patients revealed
that ACE inhibitors, but not other antihypertensives, were associated with lower
risk for rupture.
No known medical treatment prevents rupture of an
abdominal aortic aneurysm (AAA). However, animal studies have
suggested that the renin–angiotensin system may contribute to the
development of aneurysms and that angiotensin-converting–enzyme (ACE)
inhibitors, but not other antihypertensive drugs, may delay their
expansion and rupture. To test this hypothesis in humans, Canadian
investigators compared 3379 patients hospitalized for ruptured AAAs
and 11,947 patients hospitalized for unruptured AAAs between 1992 and
2002. The two groups were similar in demographics and health status.
Patients who had received an ACE inhibitor in the 3
months prior to admission had a significantly smaller likelihood of
aortic rupture than patients who had not received an ACE inhibitor
(odds ratio, 0.82). After adjustment for potential confounders, findings
were similar for each of the three ACE inhibitors used most often (enalapril,
lisinopril, and ramipril) and for both high and low doses of these
agents, but not in patients who had stopped taking their ACE
inhibitor before being hospitalized. No other class of medication,
antihypertensive or otherwise, was associated with a reduced risk for
rupture.
Comment: This case-control study will not immediately change
clinical practice (except perhaps in patients with abdominal aortic
aneurysms who have no surgical options), but it should provoke
randomized studies to further assess the value of ACE inhibitors in
patients with AAAs.
— Bruce Soloway, MD
Published in Journal Watch September 26, 2006
Citation(s):
Hackam DG et al. Angiotensin-converting enzyme inhibitors and aortic rupture: A population-based case-control study. Lancet 2006 Aug 19; 368:659-65.