Table 3. Use of ARBs in management of MFS patients.
| Study/authors (reference) | Type of study | Study population (Marfan syndrome) | Results | Comments |
|---|---|---|---|---|
| Brooke et al. 2008 (22) | Retrospective data review | 18 patients: 17 treated with losartan, 1 treated with irbesartan |
Rate of change in aortic-root diameter ↓ from 3.54±2.87 to 0.46±0.62 mm per/yr on ARB therapy (P<0.001) | Study restricted to a pediatric population |
| Lacro et al. 2014 (23) | Randomized control trial | 535 patients: patients followed for 3 years, 268 treated with atenolol, 267 treated with losartan |
No significant difference in rate of aortic root dilation (aortic root z-score) on 3-year follow up (Figure 1) | (I) Higher dose of atenolol used relative to other studies; (II) only patients with aortic root Z-score of >3 included |
| Chiu et al. 2013 (14) | Randomized open label trial | 28 patients: patients followed for 35 months, 13 treated with only β-blocker, 15 treated with β-blocker + losartan |
In the β-blocker + losartan group showed lower dilation rate than the exclusive β-blocker group (0.10 vs. 0.89 mm/yr; P=0.02) | (I) Children only with mean age of 13.1±6.3 years; (II) absolute aortic diameters were recorded rather than Z-scores |
| Yetman et al. 2005 (25) | Non-randomized clinical trial | 58 patients: 32 treated with enalapril, 24 treated with atenolol, 2 received propranolol |
Improved aortic distensibility (3.0±0.3 vs. 1.9±0.4 cm2·dynes−1; P<0.02) and a reduced aortic stiffness index (8.0±2.9 vs. 18.4±3.8; P<0.05) in patients receiving enalapril compared to those receiving β-blockers | No randomization |
| Williams et al. 2012 (13) | Randomized cross-over clinical trial | 14 patients: each patient was treated with atenolol, perindopril and verapamil with interval flush out time |
No significant change in the central pressure (hence the shear stress) amongst different drug categories | (I) Small sample size; (II) short duration of follow-up |