Efficacy of losartan vs. atenolol for the prevention of aortic dilation in Marfan syndrome: a randomized clinical trial

Aims To determine the efficacy of losartanvs. atenololin aortic dilation progression in Marfan syndrome(MFS) patients. Methods and 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 aortamaximum diameter indexed by body surface areaon 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 losartanand four in the atenololgroups, 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 losartanand 1.4 mm (95% CI 0.9–1.9) in the atenololgroup, with aortic dilatation progression being similar in both groups: absolute differencebetween losartanand atenolol−0.3 mm (95% CI −1.1 to 0.4, P = 0.382) and indexed by BSA −0.5 mm/m[2][1] (95% CI −1.2 to 0.1, P = 0.092). Similarly, no significant differences were found in indexed ascending aortadiameter changes between the losartanand atenololgroups: −0.3 mm/m[2][1] (95% CI −0.8 to 0.3, P = 0.326). Conclusion Among patients with MFS, the use of losartancompared with atenololdid not result in significant differences in the progression of aortic root and ascending aortadiameters over 3 years of follow-up. [1]: #ref-2