Losartan and dissection - Helpful or hurtful?

[tjay]

I have come across so many threads on this site regarding the benefits of Losartan to avoid/manage aneurysms/dissections. Some of you have personally benefitted from it already while other are taking it as a precaution. There are even clinical trial undergoing to demonstrate this efficacy.

But what confused me was the comments from a renowned aortic surgeon Dr Craig Miller (Stanford) in the following segment. Please listen into the conversation between 51:00 – 52:00 only, in this otherwise long video:

http://www.youtube.com/watch?v=UPMXeemwPVw

Dr Miller is saying something like: Ace-inhibitors and ARBs (e.g. Losartan) are vessel dilators, hence “theoretically” can cause dissection (thru aorta dilation)??? He prefers beta-blocker.

What should we make out of it? I was actually considering Losartan for aorta protection.

thanks
TJ

 

[Agian]

What should we make out of it? I was actually considering Losartan for aorta protection.

High BP would be way more harmful than something like Losartan, which is used to lower blood pressure. If it dilates blood vessels (I don't think it works in that way), it should theoretically take some load off the aorta. Sorry, just rambling.
http://en.wikipedia.org/wiki/Losartan

 

[Carol]

Hey,It worked for me.What do you have to loose?Take it just for hbp and maybe it will help your aorta.Check out Hal Dietz at John Hopkins,he is doing the research on this.I also take a beta blocker....Carvedilol.

 

[tjay]

hi Carol,
How much Losartan do you take daily?
And yours was the abdominal aorta, correct? What was the size before and after, and over how long?
Any idea if the same benefit can be expected for aortic root and ascending aorta?
thanks very much for your guidance.

 

[Tirone]

I had a quick look into literature:

This is a small study published in the NEJM (https://www.pubmed.org/pubmed/18579813) showing beneficial effects of angiotensin II blockade in marfan patients.
Another study comparing additive effect of beta blockers and losartan (https://www.pubmed.org/pubmed/23321647): Conclusion: This randomized, open-label, active controlled trial mostly based on a pediatric population demonstrated for the first time that losartan add-on BB therapy is safe and provides more effective protection to slow the progression of aortic root dilation than does BB treatment alone in patients with MFS
And another paper looking at the effect of losartan treatment on aortic dilatation in adults with Marfan syndrome(https://www.pubmed.org/pubmed/24405899) Conclusion: In adult Marfan patients, losartan treatment reduces the aortic root dilatation rate. After aortic root surgery, losartan treatment reduces dilatation rate of the aortic arch.

Larger randomized controlled trials are underway (https://www.pubmed.org/pubmed/21239069 / https://www.pubmed.org/pubmed/19430350 )

From this quick (and NOT in-depth) look into literature, it seems as if there is quite some evidence that losartan is beneficial in aortic dilation in marfan patients. Larger trials will answer the questions especially regarding combination therapies with beta blockers. Please correct me if I'm wrong.

 

[AZ Don]

Tirone, thanks for summarizing the studies. I had trouble with your 2nd link but found the doc here: http://www.ncbi.nlm.nih.gov/pubmed/23321647

Tjay, I think what he is saying is that theoretically Losartan has an effect that may increase the risk of dissection, but at the same time it has been shown to lower the rate of aneurysm growth, which in turn lowers the risk of dissection. That's why they do these studies, to sort out this type of conflicting information, and still there are often conflicting studies (though not in the case of Losartan to my knowledge). So far it seems to me that there is more benefit than harm. I discussed Losartan with my Cardiologist and he saw no reason not to take it and possible benefit in doing so.

 

[Carol]

I take 100mg.50am 50pm. My aneurysm was only a 3 but was being watched for 2 years.I just had a ct scan in November for another reason and still GONE.Do your homework and do what is best for you.Good Luck.

 

[Tdot]

Hi folks I'm actually part if trial taking place in Canada. It's looking at effects of arbs and beta blockers on anyeursms in those with BAV. I started a previous thread on this to update progress. I just had my baseline MRI last week, still waiting for results. I have not started any meds yet.

 

[tjay]

hi Tdot,
Have you now started in the clinical study? How was the MRI, and how did its dimensions compare to that from your recent echo?
Please keep us posted.
thanks

 

[Tdot]

Hi tjay I also replied to your IM. My MRI was two weeks ago and I'm anxiously waiting results. Will update you when I get more info.

 

[tjay]

thanks for the update Tdot. Please keep us posted. And all the best for your MRI results, and the clinical trials thereafter. Hope your aorta stays stable for decades.
PS: I'm planning to make an appointment with your cardiologist in a few months time when I move to Vancouver.

 

[ottagal]

Tdot,
Good luck with your MRI results. I, too am waiting for MRI results to see if my aneurysm has changed since the summer.
When it was determined I had started an aneurysm this past year my cardiologist put me back on beta blockers. He said that there were no studies out to prove that Losarten would be beneficial to slow down aneurysms in those with BAV and all the studies have been for those with Marfans. So it is great to read that there is a clinical trial out right now that you are part of regarding this!
Will look forward to getting the results of the study so that we can know for certain whether Losarten may be of benefit for us BAVers. However, I am sure it won't be for some time.
Wishing you all the best!

Is this the clinical trial you are part of? [/I]http://clinicaltrials.gov/ct2/show/record/NCT01202721

 

[mbeard]

Hey Ottagal,

Thanks for the continued information you will provide about your MRI results and Losarten and /beta blockers. Many here are in your boat.

 

[ottagal]

Hey Ottagal,

Thanks for the continued information you will provide about your MRI results and Losarten and /beta blockers. Many here are in your boat.

Will do and thanks for thinking of me!

 

[tjay]

hi Ottagal,
Yes, please keep us posted, just as Tdot would.
The reason I started this thread was to get a concensus among ourselves (i.e. the patients) that if there is no harm, then why not use ARBs for a potential/possible benefit. Only Dr Craig Miller's comments as stated in the original thread seem to raise a 'theoretical' concern, so I wanted to get everyone's opinion here.
If there are clinical trials underway for BAV patients, that means there is at least some promise. Why not take some ourselves rather than waiting for years for the studie results to come out, IF there is no harm otherwise (even if there is no benefit proven at the moment).

Studies have been conducted on Marfan subjects, as you mentioned.. And this one at the following link seems to be subjects in general (i.e. w/o mention of BAV or marfans; i.e. general population??). If it works for average people and Marfans, i.e. people on both sides, then it has a great potential for BAVs also, don't you think?:
http://ajh.oxfordjournals.org/content/16/S1/259A.2.abstract

 

[ottagal]

hi Ottagal,
Yes, please keep us posted, just as Tdot would.
Why not take some ourselves rather than waiting for years for the studie results to come out, IF there is no harm otherwise (even if there is no benefit proven at the moment).

Studies have been conducted on Marfan subjects, as you mentioned.. And this one at the following link seems to be subjects in general (i.e. w/o mention of BAV or marfans; i.e. general population??). If it works for average people and Marfans, i.e. people on both sides, then it has a great potential for BAVs also, don't you think?:
http://ajh.oxfordjournals.org/content/16/S1/259A.2.abstract

Thanks tjay and thank you for starting this thread. That is an interesting study I will have to share with my cardiologist. Of course, he would have to agree and provide the prescription for an ARB. One of my issues is I have a tendency towards low blood pressure so taking either Beta Blockers or ARBS is a problem for me. Currently, I am taking a very small dose of a beta blocker to start out. Will let you know if anything changes.

 

[B's Mom]

Hi Everyone!

I came on to update my sons progress on Losartan this past year and found this post before I found my old one so I am updating here. Flashback...my son was diagnosed, by chance, with BAV and ascending aorta dilation when he was 7. No stenosis or regur...just mild dilation at the time...it was 27mm at 7 years old. Next visit 2 years later...valve still good, aorta now at 31, age 9. Started yearly check-ups and the next year at age 10, measurement 33. New, WONDERFUL cardio started him on Losartan at that point. We just had our yearly and there was NO change...no growth and valve still good. He had a major growth spurt and the aorta still did not enlarge. So, as you can see, every year he was progressing average of 2 mm until this last year on Losartan where he progressed zero mm! So happy. We can't make any claims for sure...but, I'll take it and he will continue to take the Losartan. Any way you slice it....God has answered my prayers. Blessings to all.

 

[tjay]

Very happy to hear that B's mom. Very good. I hope the aorta stays back at that point forever, which would mean he would have a normal size aorta for an adult in the coming years..
If you don't mind sharing, what kind of dose of losartan is he taking as a 10-11 year old?

 

[B's Mom]

Thanks for you kind words tjay! I hope it stays stable too. Your one post is exactly WHY his doc put him on. Losartan is a safe drug that has been around quite some time and safety proven. Lowering pressure is good for BAV'ers with/without dilation of aorta AND it had the potential positive impact on the aorta. So, he said the same thing....Why wait? He said if it works we will be a year ahead of the game....if it doesn't, no harm done and he would still get the lowering of blood pressure benefit. I never heard of the "theoretical" disadvantage from it. All I know is my son's aorta stabilized for this past year when it had not before. He takes the max dose of 100mg. 50 in the am and 50 in the pm. His doc follows Dr. Dietz/s lead and dosing is very important in order for it to be effective.....it has to be high enough. My son is 5'6" and 120 plus pounds. My best to all with this......very promising and a God send!

 

[Tdot]

Awesome news!